THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 


GIFT  OF 

SAN  FRANCISCO 
COUNTY  MEDICAL  SOCIETY 


KADIUM 

3328 

AND 

KADIOTHEKAPY 


RADIUM,  THORIUM,  AND  OTHER  RADIO-ACTIVE 
ELEMENTS  IN  MEDICINE  AND  SURGERY 


BY 

WILLIAM   S.  iNEWCOMET,  M.D. 

PROFESSOR    OF   ROENTGENOLOGY  AND     RADIOLOGY,    TEMPLE    UNIVERSITY,    MEDICAL   DEPART- 
MENT;  PHYSICIAN   TO   THE     AMERICAN    ONCOLOGIC   HOSPITAL;    FELLOW    OF  THE 
COLLEGE    OF   PHYSICIANS,    PHILADELPHIA. 


ILLUSTRATED  WITH   71    ENGRAVINGS 


LEA   &   FEBIGER 

PHILADELPHIA   AND    NEW   YORK 
1914 


Entered  according  to  the  Act  of  Congress,  in  the  year  1914,  by 

LEA   &  FEBIGER, 
in  the  Office  of  the  Librarian  of  Congress.     All  rights  reserved. 


library 

U/Nl 

3tfO 


TO 

MY  WIFE 


593023 


PREFACE. 


THE  creation  of  this  work  has  been  prompted  by  the 
many  solicitations  of  the  author's  friends  and  the  inquiries 
of  many  others  as  to  where  it  might  be  possible  to  obtain 
authoritative  information  upon  the  subject  of  radium  and 
its  scientific  and  medicinal  properties.  The  reason  for  these 
queries  is  that  if  the  medical  literature  of  the  day  is  carefully 
examined,  it  will  be  found  that  articles  upon  radio-activity 
in  the  English  language  are  exceptional.  This  is  in  marked 
contrast  with  the  literature  of  other  languages,  particularly 
German  and  French,  in  which  the  most  active  interest 
prevails. .  While  this  contrast  is  very  apparent  it  is  not 
altogether  without  foundation,  for  in  this  country  it  has 
been  difficult  to  procure  the  radio-active  materials.  It  is 
possible  that  the  relation  of  our  public  institutions  to  their 
attendant  physicians  may  be  a  factor;  for  wherever  these 
valuable  salts  have  been  acquired,  the  investigator  has 
been  obliged,  in  almost  every  instance,  to  bear  the  expense. 
Another  fact  that  has  to  some  extent  discouraged  American 
investigation  is  that  most  of  the  radium  brought  to  this 
country  has  been  in  the  hands  of  private  speculators;  and 
in  some  instances,  which  have  recently  been  brought  to 
the  attention  of  the  profession,  an  exorbitant  price  was  paid 
for  an  extremely  poor  quality  of  radium.  The  purchaser, 
laboring  under  the  delusion  that  he  had  obtained  a  specimen 


Vl  PREFACE 

of  sufficient  strength  to  treat  a  certain  condition,  applied 
it  and  obtained  an  unfavorable  result;  then,  after  repeating 
the  operation  several  times,  only  to  meet  with  defeat  and 
final  discouragement,  deserted  the  whole  field,  believing 
it  worthless.  Therefore  it  is  necessary  to  warn  those  who 
enter  upon  this  study  either  to  familiarize  themselves  to 
some  extent  with  the  physics  involved,  or  have  some 
physicist  of  standard  reputation  assist  them  in  their  work. 
If,  therefore,  this  volume  saves  the  novice  from  the  errors 
which  have  been  so  common  in  the  past,  the  author  will 
feel  that  its  mission  has  not  been  in  vain. 

Considerable  space  has  been  devoted  to  the  chemistry 
and  physics  of  these  radio-active  elements,  in  the  belief 
that  some  conception  of  their  properties  will  aid  materially 
in  the  interpretation  of  their  therapeutic  action,  and  that 
they  should  be  studied  exactly  as  a  drug  that  is  employed 
in  medicine,  where  the  knowledge  of  its  botany  and  chemistry 
is  not  only  considered  useful  but  necessary.  The  details 
and  mathematical  calculations  have  been  largely  omitted; 
for  this  information  the  reader  is  referred  to  books  deal- 
ing alone  with  radio-activity.  In  the  medical  portion 
the  details  of  many  different  processes  for  the  same 
indication  are  often  given;  the  reason  for  this  is  that, 
though  they  may  apparently  give  the  same  result,  it  may 
be  impossible  always  to  use  a  given  form  of  application. 
Therefore  a  knowledge  of  several  methods  makes  it  possible 
for  the  physician  to  select  one  which  meets  the  requirements 
of  the  individual,  and  while  some  methods  mentioned  are 
not  always  the  most  approved  forms,  this  fact  has  been 
duly  noted.  In  short,  the  object  of  this  volume  is  to  place 
the  subject  of  radio-activity  before  the  medical  public  in  a 
clear  and  comprehensive  manner. 


PREFACE  vil 

The  author  desires  to  make  acknowledgment  to  the 
following  authors  whose  works  he  has  consulted  in  the 
preparation  of  his  text:  Rutherford,  Frederick  Soddy, 
Wickham  and  Degrais;  to  Mr.  Pinch  and  Mr.  Alton  of 
the  London  Cancer  Institute;  to  Professor  Lazarus  of 
Berlin,  Bayet,  Loewenthal,  Wichman,  and  others  men- 
tioned under  the  different  headings  of  their  articles;  to 
the  Trustees  and  my  associates  of  the  American  Oncologic 
Hospital,  who  have  made  it  possible  to  continue  the  study, 
and  especially  Dr.  C.  B.  Longenecker  for  his  many  and 
able  suggestions. 

W.  S.  N. 

PHILADELPHIA,  APRIL,   1914, 
3501  BARING  STREET. 


CONTENTS. 


CHAPTER    I. 
HISTORY  OF  THE  DEVELOPMENT  OF  RADIO-ACTIVITY. 

Periodic  Law  of  Matter — Early  Philosophers — Crookes'  Phenomena 
— Radiant  Matter — Roentgen  Rays — Becquerel  Rays — Dis- 
covery of  Radium — Introduction  into  Medicine 17 


PART  I. 

CHEMISTRY    AND    PHYSICS    OF   THE    RADIO-ACTIVE 
ELEMENTS. 


CHAPTER   II. 
THE  RADIO-ACTIVE  ELEMENTS. 

General  Considerations — Uranium,  Uranium  X — -Ionium — Radium, 
Radium  Emanation,  Active  Deposit  of  Rapid  Change,  Radium 
A,  Radium  B,  Radium  C1  and  C2 — Active  Deposit  of  Slow 
Change,  Radium  D  (Radio-lead),  Radium  E,  Radium  F  (Polo- 
nium)— Radium  Commercially — Thorium,  Mesothorium,  Radio- 
thorium,  Thorium  X — Thorium  Emanation — The  Active  Deposit 
of  Rapid  Change,  Including  Thorium  A,  B,  C,  and  D — 
Thorium  Commercially — The  Actinium  Group — Conclusions  .  21 


CHAPTER    III. 

RADIO-ACTIVITY. 

Definition — The  Alpha-ray — The  Beta-ray — -The  Gamma-ray — 
Helium — Comparison  of  the  a-,  0-,  and  j'-rays  with  the  Rays 
Generated  in  a  Crookes  Tube — Equilibrium — Period  of  Life — 
lonization — Properties  Causing  Fluorescence — Phosphorescence 
— Heat  and  other  Physical  Phenomena 48 


CHAPTER    IV. 

METHODS  OF  ESTIMATING  RADIATION. 

The  Standards  Used  in  Estimating  the  Amount  of  Radiation  and 
Methods  Employed  to  Obtain  Them — -The  Alpha-ray  Unit — 
The  Curie — Mache  Unit — Other  Units — Methods  of  Estima- 
tion— lonization— Electroscopes  of  Various  Forms — Fluorescent 
Method — Photographic  Method 68 

CHAPTER   V. 

RAEHUM. 

Methods  of  Employing  Radium — Local — -Direct  Application — 
Bandages — Clothing — Protected  in  an  Applicator — Direct  Appli- 
cation of  the  Emanator — Water— Charcoal — Protected  Appli- 
cators-— Apparatus  Used  to  Collect  the  Emanation — Use  of 
Radium  in  Internal  Medicine — Use  of  the  Emanation — Baths — 
Injection — Hypodermically  — Intravenous — Absorption  during 
Inspiration 86 

CHAPTER    VI. 

THORIUM. 

Practical  Use  in  Medicine — Difficulties  of  Determining  Actual 
Amount  of  Radiation — Local  Application — Methods — Use  in 
Internal  Medicine — Thorium  X — Emanation — Radiothorium — 
Conclusions  .  106 


CHAPTER    VII. 

ACTINIUM  AND  URANIUM. 

Practical  Use  of  Actinium  in  Medicine — Comparison  with  Radium  and 
Thorium — Methods  Used  for  Local  Application — Use  in  Internal 
Medicine — Uranium— Local  Use — Uranium  X — Comparison  with 
Other  Radio-active  Elements  115 


CHAPTER   VIII. 

PHYSICAL  PROPERTIES  OF  APPARATUS. 

The  Basis  of  Construction — Distribution  of  the  Salts — Toiles — 
Naked  Salts  —  Applicators  —  Radiodes — Covers  —  Maturation — 
Cashe — Filters  or  Screens — Applicators — "Cross  Fire" — Prepara- 
tion of  Apparatus — Preparation  of  the  Patient — Surface  Cases — 
Deep  Cases — Cavities  —  Implantation  —  Use  of  Radio-active 
Wax — Use  of  Emanation  in  Applicators 120 


CONTENTS  Xl 

PART  II. 

PHYSIOLOGY   AND    THERAPEUTICS. 

CHAPTER   IX. 

PHYSIOLOGICAL   ACTION. 

Effects  Observed  from  Local  Radiation — Reaction — Burns — Relief 
from  Pain — Selective  Action — Stimulation,  its  Significance — • 
Effects  upon  Bacteria — Systemic  Disturbances  from  Local  Appli- 
cations— Internal  Administration  of  Soluble  and  Insoluble  Salts 
— Effects  of  Physiological  Doses  upon  the  Heart — Alterative, 
Stimulant,  and  Diuretic  Action — Comparison  of  a-,  ft-,  and 
/-rays  with  x-rays — Influence  of  these  Rays  upon  x-ray  Burns  143 

CHAPTER   X. 

THERAPEUTIC  VALUE  OF  NATURAL  WATERS  AND  MINERALS. 

Springs — Wells — Spas — Emanatoria — Baths — Drinking-water — Local 

Application — Mud — Their  Application — Uranium  Minerals   .      .      166 

CHAPTER   XI. 

APPLICATION  IN  DERMATOLOGY. 

Principles  Involved  in  Treatment — Diseases  of  the  Hair — Keratosis — 
Eczema  —  Pruritus  —  Herpes  Zoster  —  Ichthyosis  —  Lichen  — 
Psoriasis — -Xeroderma — Acne — Syphilis — Lupus 175 

CHAPTER   XII. 
APPLICATION  IN  OPHTHALMOLOGY. 

Action  upon  Inflammatory  Conditions  —  Tuberculous  Infections  — 
Trachoma — Spring  Catarrh — Glaucoma — Keloids — Scars  upon 
the  Lids,  and  Other  Local  Conditions 190 

CHAPTER   XIII. 

APPLICATION  IN  DISEASES  OF  THE  EAH,  NOSE,  AND  MOUTH. 

Inflammatory  Diseases — Deafness — Tinnitus  Aurium — Nasal  Polypi 
—  Diseases  of  the  Mucous  Membrane  —  Caries  —  Pyorrhea  — 
Malignant  Diseases 194 


xil  CONTENTS 

CHAPTER   XIV. 

APPLICATION  IN  DISEASES  OF  THE  GENITO-URINABY  SYSTEM. 

Cystitis — Sexual"Neurasthenia — Inflamed  Prostates — Enlarged  Pros- 
tates— Chronic  Urethritis — Venereal  Warts — Tumors — Malig- 
nant Diseases 197 

CHAPTER   XV. 

«  APPLICATION  IN  GYNECOLOGY. 

Method  of  Application — External  Vegetations — Urethritis — Vagiiiitis 

— Metritis — Fibroid  Tumors — Malignant  Diseases      ....      202 

CHAPTER   XVI. 
APPLICATION  IN  EPITHELIOMATA  AND  CABCINOMATA. 

Consideration  for  Selection  of  Cases — Comparison  of  Published  Lists — 
Epithelioma  of  the  Face,  Lip,  Mouth,  Pharynx,  Larynx,  and 
Hands — From  Roentgen-ray  Burns  and  Degenerated  Scar  Tissue 
— Carcinoma  of  the  Stomach,  Rectum,  Intestinal  Tract — Liver, 
Gall-bladder,  Pancreas,  Breast,  and  Thyroid 213 

CHAPTER   XVII. 
APPLICATION  IN  SARCOMATA. 

General  Considerations  of  Sarcoma — Diseases  of  Bones  and  Joints — 
Head  —  Glioma — Lymphosarcoma —  Lymphadenoma  —  Mycosis 
Fungoides — Idiopathic  Hemorrhagic  Sarcoma — Sarcoma  of  the 
Sternum 247 

CHAPTER   XVIII. 

APPLICATION  IN  BENIGN  TUMORS. 

Keloids — Warts : —  Papillomata — Cysts — Adenitis  —  Goitre — Angio- 

mata — Nevi — Pigmented  Moles — Granulomata 257 

f CHAPTER   XIX. 
ANALGESIC  EFFECTS. 

Relief  of  Pain  from  the  Roentgen  Rays;  from  Radio-active  Elements 
— Neuralgias — Herpes  Zoster — Pruritus — Application  of  Radio- 
active Mud — Baths — Compresses  and  Packs — Conclusions  .  .  275 


CONTENTS  xiii 

CHAPTER   XX. 

RADIUM    IN   INTERNAL   MEDICINE. 

Its  Absorption  and  Elimination — Dosage — Effects  upon  the  System — 
Diseases  in  which  it  has  been  Employed — Centra-indications — 
Conclusions 280 

CHAPTER   XXI. 
THORIUM  IN  INTERNAL  MEDICINE. 

Properties  of  Thorium — Lethal  Doses — Methods — Rheumatism — 
Cout — Anemia — Leukemia — Diseases  of  the  Circulatory  and 
Nervous  Systems 289 

CHAPTER   XXII. 

RHEUMATISM,  GOUT,  AND  ALLIED  DISEASES. 

Radium  Salts  in  Solution — Emanation  in  Solution — Arthritis,  Acute 

and  Chronic — Infectious  Arthritis — Arthritis  Deformans — Gout     298 

CHAPTER   XXIII. 

TREATMENT  OF  UNTOWARD  EFFECTS  OF  RADIO-ACTIVE  ELEMENTS. 

Acute     Burns — Chronic     Dermatitis — Comparison     with     Roentgen 

Burns — Thorium  Dermatitis  .  306 


RADIUM  AND  RADIOTHERAPY. 


CHAPTER  I. 

HISTORY  OF  THE  DEVELOPMENT  OF  RADIO- 
ACTIVITY. 


Periodic  Law  of  Matter — Early  Philosophers — Crookes'  Phenomena — • 
Radiant  Matter — Roentgen  Rays — Becquercl  Rays — Discovery  of  Radium 
— Introduction  into  Medicine. 


THE  casual  observer  might  regard  the  discovery  of  radium 
by  Madame  and  Professor  Curie  as  one  of  those  fortunate 
accidents  which  often  bring  a  world-wide  fame.  This, 
however,  was  not  the  case,  for  if  one  should  take  the 
trouble  to  seek  the  facts,  it  would  be  found  that  this  dis- 
covery was  rather  the  culmination  of  a  chain  of  more  or 
less  remarkable  events  that  lead  us  back  to  the  remote 
period  of  a  century  and  a  half,  when  Mendelieyeff  advanced 
his  theory  of  "the  periodic  law  of  matter;"  and  while  this 
philosopher  was  not  an  alchemist,  and  possibly  did  not 
believe  in  the  actual  transmutation  of  elements,  he  regarded 
all  things  as  being  composed  of  one  essential  base,  "matter," 
and  pointed  out  that  there  existed  a  given  relation  between 
all  elements  known  at  that  day,  which  were  very  few, 
possibly  only  between  twenty  and  thirty  of  the  more 
common  ones,  such  as  oxygen,  hydrogen,  sulphur,  gold, 
and  others  of  that  nature ;  and  he  still  further  predicted  that 
2 


18     HISTORY  OF  DEVELOPMENT  OF  RADIO-ACTIVITY 

as  other  elements  would  be  discovered,  they  would  take 
their  place  in  line  according  to  a  given  relation,  and  in 
their  order  they  would  have  certain  qualities. 

This  theory  at  that  period  was  not  accepted,  and  being  far 
in  advance  of  the  time,  his  ideas  were  regarded  as  fanciful ; 
however,  as  one  element  after  the  other  was  discovered, 
each  taking  its  place  in  this  table,  according  to  his  "periodic 
law,"  the  truth  was  finally  established.  Later  the  atomic 
theory  of  matter  was  adopted,  and  each  element  was  sup- 
posed to  be  composed  of  a  great  number  of  minute  particles 
having  certain  characteristics,  and  they  became  known  as 
atoms.  About  this  time  a  number  of  other  philosophers 
contributed  their  portion  in  advancing  the  more  intricate 
principles  of  physical  details  so  essential  for  these  future 
experiments:  Franklin,  with  his  electrical  experiments; 
Michael  Farraday,  with  his  batteries;  and  a  debt  of  gratitude 
is  due  von  Guericke  for  development  of  the  air  pump  with 
the  later-day  improvement  to  Sprengel;  also  to  Geissler  for 
his  studies  in  the  low  vacuum  tubes  and  the  characteristic 
of  the  electric  discharge  in  air  at  different  pressures,  which 
might  be  said  to  have  been  the  forerunner  of  Sir  William 
Crookes'  discoveries  in  the  high  vacuum  tube,  afterward 
known  as  Crookes'  tubes. 

While  studying  these  tubes  some  peculiar  phenomena  were 
noticed,  which  at  that  time  were  supposed  to  be  due  to 
matter  in  another  condition,  to  which  Crookes  gave  the 
name  of  "radiant  matter."  In  this  form  it  was  found 
possible  to  penetrate  solids,  and  it  was  supposed  that  the 
atoms  of  one  mass  passed  between  the  atoms  of  the  other, 
or  that  matter  in  this  ethereal  state  existed  in  a  much  more 
rarefied  state  than  even  the  lightest  of  gases.  Wiedermann, 
J.  J.  Thomson,  Hertz,  and  others,  continued  their  studies, 


HISTORY  OF  DEVELOPMENT  OF  RADIO-ACTIVITY     19 

but  it  was  not  until  two  decades  later  that  Lenard  pointed 
out  the  true  character  of  these  particles  as  cathode  rays 
which,  a  year  or  two  later,  led  Roentgen  to  discover  the 
ar-rays. 

With  the  explanation  of  the  character  of  these  peculiar 
phenomena,  which  had  for  some  time  so  completely  baffled 
physicists,  the  way  was  opened  to  the  discovery  of  a 
number  of  other  mysteries,  and  the  year  following  Henri 
Becquerel,  in  Paris,  observed  that  similar  rays  to  the 
.r-rays  were  given  off  by  certain  minerals  and  chemicals 
which  contain  uranium;  to  some  extent  they  resemble  the 
a'-rays  from  the  Crookes  tube.  From  his  study  and  de- 
scription of  these  rays  they  were  for  the  time  known 
as  the  Becquerel  rays;  the  fact  that  they  were  a  bundle  of 
three  different  rays  led  to  confusion,  which  was  augmented 
by  the  misunderstanding  of  the  relation  of  these  rays  to 
those  of  the  Crookes  tube.  Further  misinterpretation  was 
caused  when  it  was  found  that  the  active  portion  of  the 
mineral  or  salt-containing  uranium  element,  or  that  portion 
giving  off  these  rays,  could  be  separated  and  that  in  time 
these  uranium  bases  from  which  it  was  obtained  would 
regenerate. 

Many  physicists  and  chemists  were  at  this  time  giving  this 
problem  their  greatest  attention,  and  four  years  after  the 
discovery  by  Becquerel,  in  1900,  M.  Schmidt,  with  Professor 
and  Madame  Curie,  working  independently  of  each  other, 
were  able  to  isolate  radium,  which  has  revolutionized  the 
whole  scientific  world,  added  thirty  or  more  new  elements  to 
those  already  known,  and  created  an  entirely  new  field  for 
active  study — radio-activity.  For  its  advancement  we  are 
indebted  to  such  men  as  Razet,  Sagnac  (particularly  for 
his  studies  of  the  secondary  rays),  Rutherford  for  explana- 


20     HISTORY  OF  DEVELOPMENT  OF  RADIO-ACTIVITY 

tion  of  the  relation  of  the  different  rays  and  gases  eliminated 
by  these  radio-active  substances,  Debierne,  Giesel,  Lord 
Kelvin,  Meyer,  Frederick  Soddy,  and  many  other  physicists. 
Strange  as  it  may  seem,  yet  like  many  of  our  other 
most  useful  tools  in  medicine,  the  actual  suggestion  for 
the  use  of  radium  as  a  therapeutic  agent  came  from  two 
physicists,  Henri  Becquerel,  who  observed  a  decided 
inflammatory  reaction  upon  the  skin  beneath  the  site 
of  his  pocket,  in  which  he  imprudently  carried  a  small  tube 
of  radium;  and  secondarily  to  Professor  Curie,  who  loaned 
a  sufficient  quantity  of  this  valuable  element  to  M. 
Danlos,  of  the  St.  Louis  Hospital  in  Paris,  for  study 
of  its  action  upon  cases  at  that  institution.  While  the 
advancement  in  this  field  has  not  been  rapid,  due  mainly 
to  the  difficulty  in  procuring  a  sufficient  supply  of  radium, 
steady  strides  have  been  made,  and  the  demand  is  now  far 
in  excess  of  the  supply.  There  is  a  prospect  of  gaining  a 
certain  amount  of  relief  through  the  application  of  thorium 
preparations,  which,  according  to  some  authorities,  are 
claimed  to  be  superior  to  those  of  radium,  due  to  their  more 
rapid  disintegration,  and  therefore  greater  activity  within  a 
certain  mass.  There  are,  however,  wide  differences  between 
these  preparations,  and  it  would  seem  that  both  will  have 
a  given  range  of  usefulness. 


PART  I. 

CHEMISTRY  AND  PHYSICS  OF  THE  RADIO- 
ACTIVE ELEMENTS. 


CHAPTER   II. 
THE  RADIO-ACTIVE  ELEMENTS. 

General  Considerations — Uranium,  Uranium  X — Ionium — Radium, 
Radium  Emanation,  Active  Deposit  of  Rapid  Change,  Radium  A, 
Radium  B,  Radium  C1  and  C2 — Active  Deposit  of  Slow  Change, 
Radium  D  (Radio-lead),  Radium  E,  Radium  F  (Polonium) — Radium 
Commercially — Thorium,  Mesothorium,  Radiothorium,  Thorium  X — 
Thorium  Emanation — The  Active  Deposit  of  Rapid  Change,  Including 
Thorium  A,  B,  C,  and  D — Thorium  Commercially — The  Actinium  Group 
— Conclusions. 

THERE  are  over  thirty  elements  which  are  radio-active, 
and  while  the  existence  of  some  of  them  is  a  matter  of  only 
a  few  seconds,  or  even  the  cycle  of  a  second,  they  are  to  be 
regarded  in  the  same  light  as  iron,  copper,  or  calcium,  having 
all  the  properties  of  other  elements,  in  regard  to  atomic  weight, 
capacity  for  heat,  specific  gravity,  and  existing  in  such  forms 
as  solids,  liquids,  or  gases.  The  majority  of  these  elements 
belong  to  three  distinct  groups,  known  as  that  of  uranium, 
thorium,  and  actinium,  and  while  there  may  be  other  com- 
mon elements  which  are  radio-active,  they  exist  in  a  form 
which  at  the  present  day  we  do  not  recognize.  It  may 
surprise  many  to  learn  that  potassium  and  rubidium  are 


22 


THE  RADIO-ACTIVE  ELEMENTS 
FIG.  1 


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4>     •  •  P  * 

THORIUM  X                       X"^v 

RADIUM                                f     \       p. 
(2i500  YEARS)                   ^zze.^-*^ 

ACTINIUM  X. 
(51  DAYS) 

QK>* 

(5.35  DAYS)                     (^j*O    « 

1 

i 

1 

EMANATION                        /^^\        _ 
(5.57  DAYS)                       U22.4J->(ja 

EMANATION 
(5.6  SECONDS) 

O^Oc, 

EMANATION                      ^T^\     (^v 
(76  SECONDS)                 ^loy-^lj    tt 

| 

Jt 

'  RADIUM  A                            /^~\ 

^ACTINIUM  A 

THORIUM  A                      /"      N      _ 

(4.3  MINUTES)                 \^/^ 

(0.0029 
SECOND) 

-»Oa 

(0.203  SECOND)             V_l/ 

1 

RADIUM  B                            f     \            ._, 
(38.5  MINUTES)              (^14.4^  -»•  •(  pV 

ACTINIUM  B 
(52.1   MINUTES) 

O-v 

THORIUM  B                      S^~~\            .  _ 
(15.3  HOURS)                 ^212)-»»(.P 

RADIUM  Cj                      |    /      N 
(28.1   MINUTES)              v"^!"*        * 

ACTINIUM  Cj 
(3.  10  MINUTES) 

JO'0« 

THORIUM  Cj                 T/^"^      ,0 
(79  MINUTES)                 (  212)-*O 
I         i 

J         |        *f3i7 

•i  * 

i  A 

1     x  —  v 

THORIUM  C0                1(1      O   a 

RADIUM  C2                     III           « 

(ACTINIUM  cJ?) 

O-*O  a 

(1.9  MINUTES)              I  \^]x 

^ 

•'                             l^  ' 

1 

I 

^1 

RADIUM  D                            S      \            ,c\ 

ACTINIUM  D 

THORIUM  D                      /       \             a 

(24  YEARS:)               hio.4j-*«  p 

(7.4  MINUTES) 

-*»/3o 

(4.5  MINUTES)                ^203^       "  Pi 

RADIUM  E                            X^v 
(7.25  DAYS)                      (J1<1-<)"*1*P&7 

ACTINIUM  E 
(UNKNOWN) 

6 

THORIUM  E                      /"     \ 
(UNKNOWN)                     V^  / 

RADIUM  F                             >*«v 

(POLONIUM)                fito^WO  a 

(202  DAYS)                         X_X 

1 

RADIUM  G                             s^-~\ 

(PROBABLY                        (208.4J 

LEAD)                                    >  ' 

• 

Disintegration  series  of  uranium,  radium,  thorium,  and  actinium. 


URANIUM  23 

radio-active  but  very  feebly,  and  at  present  it  is  only 
an  interesting  physical  fact.  But  it  is  for  the  future  to 
develop,  and  no  doubt  in  time  our  common  potash  may  be 
a  peer  of  radium,  or  perhaps  analogous  to  uranium  at  the 
head  of  the  disintegration  series. 

URANIUM. 

Uranium. — Atomic  weight,  236.7.  Specific  gravity,  18.6. 
Period  of  average  life  about  8,000,000,000  years.  Found  in 
nature  as  black  oxide,  pitchblend;  also  as  uranates  in  com- 
bination with  calcium,  and  often  associated  with  mica  ores, 
clevite,  the  hydrated  oxide,  and  in  carnotite  where  it  is  com- 
bined with  vanadium.  Other  rocks  contain  it  as  gummite, 
autunite,  samarskite,  and  many  other  forms.  It  is  widely 
disseminated  throughout  the  world's  crust,  but  only  found 
in  workable  quantities  in  Hungary,  Bohemia,  and  in  the 
United  States  in  a  few  widely  separated  places. 

Chemically  it  forms  two  combinations  with  oxygen, 
UrO2,  and  UrOa;  forming  two  classes  of  salts,  the  uranic 
and  uranous.  Most  of  the  salts  are  possessed  of  a  brilliant 
canary-yellow  color;  some,  however,  are  a  bright  red.  A 
few  of  them  become  brilliantly  fluorescent  under  the  influence 
of  certain  rays. 

The  separation  of  uranium  from  the  different  minerals  in 
which  it  is  found  is  effected  by  dissolving  them  in  nitric 
acid,  then  adding  an  excess  of  sodium  carbonate;  this 
forms  a  combination  of  sodium  uranate  which  is  afterward 
purified  by  repeating  the  process. 

Radio-activity. — Pure  uranium,  and  all  uranium  salts  that 
are  freshly  prepared,  give  off  only  an  a-radiation;  two 
a-particles  for  each  atom  of  uranium;  but  at  the  end  of 


24 


THE  RADIO-ACTIVE  ELEMENTS 


three  weeks  from  the  time  of  preparation  they  have  gained 
about  one-half  their  equilibrium,  from  the  accumulation, of 
uranium  X,  which  gives  off  /3-raysof  fair  strength  and  a  rather 
feeble  7-radiation.  The  perfect  equilibrium  is  gained  in 
about  one  year. 

Uranium  n  has  an  atomic  weight  of  234,  although  it  has 
not  been  definitely  separated;  there  is  reason  to  believe  its 
period  of  life  is  about  2,000,000  years  and  is  closely  asso- 
ciated with  uranium;  it  gives  off  a-particles. 

FIG.  2 


10 


100  DAYS 


Diagram  illustrating  the  decay  of  uranium  X,  and  the  recovery  of 
uranium. 

Uranium  X,  to  which  reference  has  just  been  made,  is  the 
disintegration  product  of  uranium  II.  The  average  period 
of  life  is  about  35.5  days.  Its  disintegration  product  is  un- 
known, and  while  a  uranium  Y  has  been  described  with  the 
short  life  of  1.5  days,  from  a  medical  standpoint  its  usefulness 
is  nil, 

The  radiation  of  uranium  X  is  principally  a  (8-radiation 
with  a  rather  weak  7-ray ;  in  fact  it  is  all  cut  off  by  the  thick- 
ness of  0.95  cm.  lead.  The  period  of  half-change  is  24.6  days. 


RADIUM  25 

Uranium  X  is  prepared  by  allowing  a  hot  solution  of 
uranyl  nitrate,  2.05  specific  gravity,  to  crystallize;  upon 
cooling  the  mother  liquor  will  contain  about  six-sevenths 
of  the  uranium  X.  Another  method  is  to  add  a  small  quan- 
tity of  ferric  chloride  to  a  solution  of  uranium  and  then 
precipitate  the  iron  by  ammonia  carbonate;  the  uranium 
X  fixes  itself  to  this  hydrated  iron  carbonate,  the  solution 
may  be  filtered,  and  the  activity  is  entirely  in  the  iron 
precipitation. 

In  medicine,  from  a  therapeutic  stand-point,  uranium 
nitrate  has  been  employed  in  the  treatment  of  diabetes;  its 
use  seems  to  be  purely  empiric.  Radiologically  it  is  the 
uranium  X  that  is  of  some  value,  and,  has  been  used  in  the 
treatment  of  surface  epitheliomas  and  lupus,  either  com- 
pounded in  ointments  or  the  mineral  containing  uranium 
(crystal  of  autunite)  applied  directly  to  the  diseased  part. 
Howrever,  it  has  not  been  generally  accepted  and,  therefore, 
its  practice  is  extremely  limited. 

Ionium. — Ionium  stands  between  the  uranium  group 
proper  and  radium.  Very  little  is  known  of  this  element, 
which  is  most  difficult  to  separate;  it  possesses  a  low  range 
of  a  rather  fair  amount  of  a-radiation,  which  is  entirely  lost 
in  2.8  cm.  of  air.  Its  parent  is  supposed  to  be  uranium  X, 
which  has  not  been  proven.  Its  life  is  about  1,000,000 
years,  and  its  disintegration  product  is  radium.  Chemically 
it  is  so  much  like  uranium  X  and  thorium  that  it  is  doubt- 
ful if  pure  ionium  has  even  been  produced. 

RADIUM. 

Radium. — Radium  is  found  in  all  minerals  containing 
uranium,  although  in  somewhat  different  proportions, 


26  THE  RADIO-ACTIVE  ELEMENTS 

depending  upon  the  formation  from  a  geologic  standpoint; 
the  older  the  mineral  the  greater  the  accumulation  of  radium 
with  its  series  of  disintegration  products.  In  the  great 
majority  of  specimens,  however,  the  proportion  of  radium 
to  uranium'  is  3.2  X  10~7,  or  about  320  milligrams  per  ton. 
Radium  is  much  more  widely  disseminated  than  is  usually 
supposed,  practically  all  the  rocks,  water  from  springs,  and 
even  sea  water  contain  an  infinitesimal  quantity,  which  is 
detectable  by  suitable  apparatus. 

AMOUNTS  OF  RADIUM  CONTAINED  IN  DIFFERENT  ORES. 

Pitchblend  from  Johanngeorgenstadt       .      .      .  8.3  x  10~u 

Pitchblend  from  Joachimsthal 7.0 

Pitchblend  from  Pzi bran    . 6.5 

Pitchblend  from  Cornwall 1.6 

Clevite 1.4 

Chalcolite      ......' 5.2 

Autunite        .'.-.-..      .' 2.7 

Carnotite 6.2 

Thorite 1.4 

Orangite        .      .' 2.0 

Production. — The  first  step  in  the  manipulation  of  a 
radium-bearing  ore  depends  somewhat  upon  the  other 
associated  elements,  such  as  silica,  lead,  barium,  etc. 
They  are  first  converted  into  sulphates,  and  then  into 
carbonates;  finally,  after  sufficient  purification,  they  are 
dissolved  in  hydrochloric  acid  and  then  the  process  of 
fractionation  or  recrystallization  is  started  for  the  further 
separation  from  the  barium  salts  which  chemically  they  so 
closely  resemble.  The  crystals  contain  the  most  radium 
and  the  mother  liquor  the  least,  but  both  the  mother 
liquor  and  crystals  must  be  subjected  to  this  manipula- 
tion a  number  of  times  until  pure  radium  chloride  is  ob- 
tained. The  older  process  was  to  use  hydrobromic  acid  in- 
stead of  hydrochloric,  and  in  some  places  it  is  still  employed. 


RADIUM  27 

The  manipulation  of  this  process  would  seem  to  be  extremely 
easy,  but  when  one  realizes  a  ton  or  more  of  material  must 
be  dissolved  in  fifty  tons  of  water,  and  five  tons  of  acid,  with 
the  total  quantity  of  radium  being  300  milligrams  or  less, 
it  is  not  difficult  to  see  with  what  care  this  procedure  must 
be  carried  out. 

Radio-activity. — Radium  free  from  its  products  of  decay 
possesses  a  fair  a-radiation,  penetrating  3.13  cm.  of  air.  With 
this  there  possibly  exists  a  very  feeble  /3-radiation  which  need 
not  be  taken  into  consideration.  The  retention  of  the  products 
of  disintegration  depends  to  some  extent  upon  the  salt;  as 
for  instance,  the  sulphates  retain  them  to  a  greater  extent 
than  the  other  forms,  while  the  carbonates  allow  them  to 
escape  freely.  If,  on  the  other  hand,  any  of  the  salts  are 
in  a  sealed  tube,  the  disintegration  products  are  practically 
all  retained.  Radium  gains  its  equilibrium  in  about  one 
month,  of  which  one-half  accumulates  in  four  days.  After 
the  removal  of  the  products  of  disintegration  from  radium 
the  decay  of  its  activity  is  exactly  the  reverse.  One-half 
the  power  is  lost  in  four  days  and  then  gradually,  until 
at  the  end  of  one  month  it  has  disappeared. 

Properties. — Radium  has  been  produced  in  its  metallic 
state  but  rapidly  disintegrates.  The  most  common  salts, 
which  are  to  be  found  in  the  market,  are  the  chlorides, 
bromides,  carbonates,  and  sulphates;  the  chlorides  and 
bromides  being  soluble,  and  under  some  circumstances 
slightly  deliquescent;  the  carbonates  and  sulphates  are  in- 
soluble in  water.  Chemically  its  analogue  is  barium  except 
that  its  salts  are  slightly  less  soluble  in  water;  therefore 
radium  sulphate  is  the  most  insoluble  salt  known. 

All  the  salts  of  radium  are  luminous,  which  is  independent 
of  their  radiation,  or  the  production  of  luminescence  upon 


28  THE  RADIO-ACTIVE  ELEMENTS 

other  substances.  Radium  salts  color  the  flame  a  carmine 
tint.  Its  spectrum  exhibits  a  close  analogy  to  the  alka- 
line earths,  the  strongest  line  being  in  the  ultraviolets 
(X  =  381.47/i).  Heat  is  liberated  spontaneously  and  at 
the  rate  of  one  small  calorie,  melting  the  amount  of  ice 
equal  to  its  own  weight  every  hour.  This  is  continued  for 
about  2500  years  which  is  the  average  period  of  its  life. 
To  show  the  enormous  amount  of  energy  stored  in  radium, 
it  has  been  calculated  if  the  energy  could  be  employed 
in  the  same  manner  as  coal,  a  quantity  the  size  of  a  pin- 
head  would  be  sufficient  to  light  London  for  one  year.  The 
atomic  weight  of  radium  is  226.5;  it  belongs  to  the  fourth 
group  of  elements  or  the  alkaline  earths. 

The  methods  usually  employed  for  estimating  the  amount 
of  radium  in  combination  with  other  substances  are  by 
means  of  an  electrometer,  which  will  be  considered  under 
another  heading;  but  where  the  quantity  warrants  a  chem- 
ical examination,  it  can  be  done  by  first  obtaining  the 
radium  in  solution  as  chloride  or  bromide;  under  some 
circumstances  it  may  also  be  obtained  as  a  sulphate  but 
the  objection  to  converting  it  into  this  form  is,  that  the 
sulphate  is  extremely  insoluble  and  difficult  to  restore  to 
solution.  The  disintegration  product  of  radium  is  the 
emanation. 

Radium  emanation  (Sir  William  Ramsey  proposed  the 
name  Nitron)  is  a  gas;  its  parent  is  radium.  It  belongs  to 
that  class  of  inert  gases  which  do  not  seem  to  enter  into  chem- 
ical combination  with  other  elements  and  therefore  is  like 
nitrogen,  but  still  more  inert,  being  an  analogue  of  xenon. 
The  atomic  weight  is  222.5;  density,  111.25;  and  is  so  heavy 
that  some  elements,  such  as  mercury  or  lead,  would  float 
upon  it.  Heat  generated  from  its  disintegration  is  intense, 


RADIUM 


29 


so  much  so,  if  any  considerable  quantity  could  be  collected 
in  a  pure  state,  there  is  no  known  substance  which  could 
serve  as  a  container.  The  average  life  is  5.57  days;  period 
of  half  change,  3.86  days.  While  this  gas  has  a  rather 
short  life  it  conforms  to  all  the  natural  laws  of  other  gases. 
It  can  be  condensed  by  liquid  air,  at  a  temperature  near 
—152°  C.  It  is  soluble  in  pure  water  at  ordinary  tempera- 
ture; however,  the  solution  of  certain  salts  makes  it  less  so. 


FIG.  3 

TIME  IN  DAYS 

123456      7       8      9      10     11     12     13     14     15 


Diagram  showing  the  recovery  of  radium,  and  the  decay  of  the  emanation. 

Glycerin,  petroleum,  and  other  liquids  also  absorb  it;  cocoa- 
nut  charcoal  has  the  power  of  absorbing  it  at  ordinary  tem- 
perature; by  heating  it  strongly  the  emanation  is  driven  off. 
Other  porous  substances,  even  dense  metals,  have  the  effect 
of  absorbing  this  gas  to  some  extent,  which  often  leads  to 
error  in  the  calculation  of  radio-active  discharge.  The  vol- 
ume of  emanation  under  normal  conditions  in  equilibrium 
with  1  gram  of  radium  is  about  0.585  cubic  millimeter.  It 


30 


THE  RADIO-ACTIVE  ELEMENTS 


possesses  the  same  quality  of  discoloring  objects  as  radium; 
and  likewise  the  violet  tint  is  given  to  glass  tubes  which 
are  used  as  containers.  Water  is  separated  by  the  radio- 
activity of  these  elements  into  hydrogen  and  oxygen,  and. 
in  the  presence  of  oxygen  the  emanation  becomes  a  powerful 
oxidizing  agent  upon  organic  compounds.  These  facts  may 

FIG.  4 


Diagrammatic  apparatus  for  collecting  the  emanation.  A  given  quantity 
of  radium  salt  is  dissolved  in  water  slightly  acidulated  in  flask  A.  Pure 
air  is  then  drawn  through  the  solution  by  pump  attached  to  tube  g.  The 
air  entering  /,  passes  out  through  h,  charged  with  the  emanation,  and  may 
be  collected  in  D  if  B  contains  liquid  air,  which  causes  the  emanation  to 
condense.  If  the  tube  D  contains  a  few  broken  pieces  of  willemite  (zinc 
silicate),  the  presence  of  the  emanation  causes  it  to  emit  a  brilliant  glow. 
After  all  the  emanation  has  been  abstracted  from  the  radium  the  stop  cocks 
e  e  may  be  closed  until  it  is  desired  to  use  the  emanation.  Water,  glycerin, 
charcoal,  or  other  substances  may  be  charged  in  C. 

play  a  most  important  part  in  the  therapeutic  value  of  this 
gas  when  used  internally.  Care  should  be  taken  not  to 
allow  the  emanation  to  escape  into  the  air  of  the  room,  for, 
being  a  gas,  it  diffuses  rapidly,  and  as  it  ages  it  covers  the 
walls  and  all  objects  contained  in  the  room  with  the  lower 
disintegration  products,  rendering  them  radio-active  and 


RADIUM  31 

leaving  them  so  for  an  indefinite  period.  While  the  amount 
of  radio-activity  of  these  objects  is  very  small,  it  interferes 
to  such  an  extent  that  instruments  of  precision  can  no  longer 
be  used  in  that  building. 

Radio-activity. — This  gas  gives  off  an  a-ray  which  has  a 
range  of  3.94  cm.  in  air,  it  is  one  of  the  strongest  of  its 
class.  The  radio-active  constant  is  0.00751  (hour)-1. 

Production. — In  a  flask  a  given  quantity  of  radium  salt 
is  dissolved  in  water  that  has  been  slightly  acidulated 
with  hydrochloric  acid,  through  this  water  is  passed  a 
slow  stream  of  air  (better  by  suction);  as  the  air  passes 
through  the  solution  a  small  amount  of  the  emanation 
is  carried  along  with  it.  If  this  mixture  is  then  passed 
through  a  vessel  cooled  by  liquid  air,  the  cold  sides  of 
the  tube  condense  the  emanation  contained,  allowing  the 
air  to  pass  on.  The  proportion  of  emanation  contained  in 
the  salt  of  radium  depends  entirely  upon  its  age.  Where 
it  is  desired  to  collect  the  emanation  for  medical  use,  this 
process  must  be  slightly  modified,  and  is  described  in 
Chapter  V. 

The  product  of  disintegration  is  radium  A,  and  in  view  of 
the  fact  that  the  next  few  elements  undergo  a  very  rapid 
change  and  that  there  is  still  some  doubt  as  to  the  details 
concerning  their  actual  relation  to  one  another,  they  are 
generally  considered  under  the  head  of  "active  deposit  of 
rapid  change."  The  activity  from  a  therapeutic  standpoint 
is  chiefly  due  to  the  "products  of  rapid  change;"  here  are 
obtained  the  valuable  7  (gamma)  rays  and  with  it  the  /3 
(beta)  rays  of  different  values. 

The  "active  deposit  of  rapid  change"  is  composed  of  the 
following  elements:  Radium  A,  atomic  weight,  218.5;  period 
of  life,  4.3  minutes;  radiation  a  (alpha)  with  a  range  of 


32  THE  RADIO-ACTIVE  ELEMENTS 

4.5  cm.  in  air.  Its  decay  is  very  rapid  and  passes  into 
radium  B;  atomic  weight,  214.5;  period  of  life,  38.5  minutes; 
radiation  /3  (beta)  ray  of  which  one-half  will  pass  through  a 
sheet  of  aluminium  0.09  mm.  thick.  This  element  then 
passes  into  radium  C1,  which  also  has  the  atomic  weight  of 
214.5,  and  compares  with  radium  C2,  as  do  the  two  more 
familiar  elements,  cobalt  and  nickel;  the  life  of  this  element 
is  28.1  minutes;  alpha-  beta-  and  gamma-rays  are  given  from 
its  activity.  The  alpha-rays  have  a  range  of  6.57  cm.  in  air, 
and  it  will  be  observed  that  these  are  projected  with  more 
force  than  any  of  the  others.  The  /3-rays  are  also  projected 
with  greater  force  than  any  that  have  preceded  and  it  re- 
quires a  sheet  of  aluminium  about  0.5  mm.  thick  to  obstruct 
one-half  of  them.  The  gamma-radiation  is  here  established 
and  it  requires  a  thickness  of  1.38  cm.  of  lead  to  obstruct 
one-half  of  the  rays.  This  element  disintegrates  into  radium 
C2,  or  possibly  it  may  be  coincidently  formed,  and  has  a 
supposed  atomic  weight  of  210.5.  Its  period  of  life  is  ex- 
tremely short,  being  only  1.9  minutes;  in  its  change  it  gives 
off  a  beta-  and  gamma-radiation  which  so  far  has  not  been 
thoroughly  studied. 

The  majority  of  these  different  elements  can  be  separated 
by  extremely  elaborate  chemical  and  physical  means,  but 
at  times  it  is  often  rendered  impossible  by  certain  impurities 
being  present;  their  separation  is  of  no  importance  from  a 
medical  point  of  view,  as  most  of  the  therapeutic  property 
of  radium  is  due  to  the  "active  deposit  of  rapid  decay." 
These  elements  are  principally  of  value  as  a  whole  and  not 
separately.  After  this  very  active  cycle  the  product  of  dis- 
integration is  radium  D,  which  is  the  beginning  of  the  group 
of  "active  deposit  of  slow  change." 

The  "active  deposit  of  slow  change"    adds  a  little  more 


RADIUM  33 

activity  to  the  old  specimens  of  radium;  the  change  being 
so  slow  and  the  length  of  time  so  great  that  from  a  medical 
standpoint  there  is  very  little  difference  between  a  specimen 
of  radium  that  has  gained  its  equilibrium  from  the  products 
of  the  active  group,  and  a  very  old  one  that  has  in  addition 
to  it,  the  products  of  slow  decay.  It  must  be  remembered 
that  the  maturation  of  radium  starts  with  the  day  that  the 
crystals  are  separated  from  the  solution,  and  it  makes  very 
little  difference  how  old  the  crystals  are;  if  they  are  redis- 
solved,  at  that  time  an  entirely  new  cycle  is  started.  The 
"active  deposit  of  slow  change"  starts  writh  radium  D,  with 
a  life  of  about  twenty-four  years,  it  then  passes  into  radium 
E,  with  a  life  of  a  little  over  seven  days,  then  becoming 
radium  F.  and  in  two  hundred  and  two  days  disintegrates 
into  what  is  supposed  to  be  lead. 

Radium  D  (radio-lead)  has  an  atomic  weight  of  210.5, 
and  an  average  period  of  life  of  about  twenty-four  years;  it 
gives  off  a  very  insignificant  /3-radiation.  This  element  is, 
in  some  ways,  closely  associated  with  lead  and  is  found  in 
all  lead  and  most  uranium  ores.  While  radium  D  has  never 
been  obtained  directly  from  lead,  it  does  exist  in  all  new  lead 
and  where  electroscopes  are  to  be  constructed  from  sheet 
lead,  the  oldest  lead  possible  should  be  obtained.  While 
radium  D  is  not  very  active  its  disintegration  products  will 
be  seen  to  possess  a  fair  amount  of  radiation  which  to  some 
extent  is  a  hinderance  to  accurate  experiments  performed 
with  new  lead. 

Radium  D  is  obtained  from  old  specimens  of  radium  or 
where  the  emanation  of  radium  has  undergone  disintegra- 
tion in  an  enclosed  glass  vessel,  the  radio-lead  covers  the 
inside  as  an  invisible  film.  The  disintegration  product  is 
radium  E1  and  E2.  Here  again  there  seems  to  be  a  double 
3 


34  THE  RADIO-ACTIVE  ELEMENTS 

product  that  is  more  or  less  confused,  and  while  it  is  known 
as  radium  E  it  may  be  split  into  E1  and  E2.  The  atomic 
weight  is  supposed  to  be  about  210.5.  The  average  period 
of  life  is  7.25  days,  with  a  /3-  and  7-radiation.  Very  little 
is  understood  about  its  chemical  nature  and,  while  fairly 
active,  the  double  nature  of  this  element  produces  some 
confusion  in  the  different  processes  for  its  separation. 

Its  disintegration  product  is  polonium  or  radium  F. 
Polonium  is  of  interest  for  the  reason  that,  when  these  ele- 
ments were  first  discovered,  it  was  supposed  to  belong  entirely 
to  a  series  of  its  own  and  was  studied  directly  from  the 
minerals.  Not  until  after  careful  observation  was  it  found 
to  be  one  of  the  radium  series.  The  fact  that  it  had  a  longer 
life  than  most  of  the  others,  led  to  its  identity. 

Radium  F  (polonium — the  name  radiotellurium  was 
proposed  by  Marckwald).  Atomic  weight  about  210.5; 
average  period  of  life,  202  days.  The  quantity  of  polonium 
reaches  its  maximum  in  radio-lead  in  about  two  years 
when  it  starts  to  disintegrate  and  steadily  decays  with  its 
parent,  but  where  it  is  formed  from  radium,  confined  within 
a  closed  tube,  the  quantity  of  polonium  steadily  increases 
for  about  thirty  years;  in  the  first  ten  years  however,  very 
little  polonium  is  formed. 

Production. — Radium  F  may  be  obtained  from  minerals 
containing  uranium  and  it  is  associated  with  the  same 
class  as  bismuth  to  which  it  is  closely  allied.  It  may 
be  separated  by  several  methods.  Combined  with  bismuth 
oxychloride  it  can  be  fractionally  precipitated  with  a  strong 
solution  of  hydrochloric  acid  or  nitric  acid;  the  fractiona- 
tion  and  precipitation  being  carried  out  as  the  subnitrate. 
Another  process  is  sublimation  in  a  partial  vacuum,  the 
polonium  being  more  volatile. 


RADIUM 


35 


FIG.  5 


Radio-activity. — Radium  F  is  worthless  from  a  medical 
stand-point,  possessing  only  an  alpha-ray,  having  a  penetra- 
tion of  3.58  c.c.  in  air,  and  which  is  obstructed  by  a  thin 
sheet  of  paper. 

Its  disintegration  product  is  probably  lead. 

Radium  Commercially. — When  radium  is  purchased  in 
the  open  market,  the  product  that  is  obtained  is  one  of  the 
different  salts  in  a  more  or  less  im- 
pure state.  The  freer  it  is  of 
impurities  the  more  active  it  is 
within  a  given  mass;  however,  as 
these  impurities  only  obstruct  the 
low  rays,  they  do  very  little  harm 
from  a  medical  stand-point.  The 
most  common  salts  to  be  obtained 
are  the  carbonate  and  sulphate, 
which  are  insoluble  in  water,  and 
the  chloride  and  bromide,  which 
are  soluble,  and  somewhat  deli- 
quescent; therefore,  if  the  last  two 
are  to  be  exposed  to  the  air,  they 
must  be  carefully  protected. 

The  color  of  these  salts  is  a  light 
yellow,  modified  more  or  less  by 
the  impurities,  and  they  become 

darker  with  age.  It  will  also  change  the  color  of  the  glass 
container  in  a  short  time,  causing  it  to  become  a  violet 
color,  this  effect  is  noticed  also  upon  minerals.  It  changes 
colorless  rock  crystals  to  yellow,  then  to  brown;  rose 
quartz,  brown;  gypsum,  yellow;  diamonds,  blue  or  brown; 
calcium  chloride,  yellowish  brown;  potassium  chloride, 
violet ;  and  gives  amethysts  and  aquamarines  a  deeper  color. 


A  bottle  that  contained  a 
tube  of  radium  for  about 
two  months.  Notice  the 
violet  color  midway  between 
the  round  end  and  the  label. 


36  THE  RADIO-ACTIVE  ELEMENTS 

These  salts  contain,  according  to  their  age  and  the  manner 
in  which  they  are  preserved,  the  different  products  of  the 
emanation,  "active  deposit  of  rapid  change;"  and  old  salts 
more  or  less  the  activity  of  the  "active  deposit  of  slow 
change."  When  radium  has  gained  its  maximum  power  of 
throwing  off  these  rays,  it  is  spoken  of  as  having  gained  its 
"equilibrium;"  it  is,  in  other  words,  giving  off  its  maximum 
quantity  of  all  three  rays  and  will  continue  to  do  this  for 
some  two  thousand  years  with  very  little  change,  but  when 
the  radium  salt  has  been  freshly  crystallized,  it  requires  about 
one  month  to  gain  its  "equilibrium."  (See  table,  page  60.) 

The  impurities  contained  in  most  radium  salts  are  prin- 
cipally barium,  from  which  it  is  very  hard  to  separate  and 
with  wyhich  it  forms  a  double  salt. 

All  radium  salts  are  luminous  in  the  dark  and  they  will 
cause  a  brilliant  fluorescence  of  many  minerals  and  salts,  the 
most  important  of  them  being  the  diamond,  scheelite  (calcium 
tungstate),  platinum,  barium  cyanide,  zinc  sulphide  (zinc 
blend),  willemite,  and  many  to  a  lesser  degree,  as  gypsum, 
calcite,  etc. 

When  estimating  the  amount  of  radium  contained  within 
a  given  specimen  it  should  always  be  calculated  upon  the 
basis  of  pure  radium  element,  not  as  a  salt,  in  which  the 
actual  amount  of  radium  element  varies  with  the  proportion 
of  the  salt-forming  acid;  this  is  readily  seen  in  comparing 
the  following: 

1.87  milligrams  radium  bromide  contains  1  milligram  radium  elements. 
1.31  chloride         "        1 

1.26  "       carbonate      "        1         " 

1.42  "       sulphate        "         1 

It  is  here  shown  that  the  commonest  salt  of  commerce, 
the  bromide,  contains  the  least  radium.  This  salt  is  easy 


RADIUM  37 

to  handle  in  the  chemical  manipulation  for  the  recovery 
of  radium  and  therefore,  it  is  usually  placed  upon  the  market 
in  this  form. 

Some  of  the  more  common  radium-bearing  ores  are: 

Pitchblend,  or  uraninite,  is  a  uranium  oxide.  The  mineral 
looks  like  pitch  but  is  very  heavy,  usually  found  in  deep 
mines,  in  the  older  geologic  formation,  where  the  amount 
of  radium  runs  somewhat  higher  than  in  other  forms. 
Some  pitchblends  are  comparatively  free  from  thorium,  but 
always  associated  to  some  extent  with  actinium.  Torbernite 
uranite  and  uran-mica  which  contains  the  uranium  phos- 
phate is  associated  with  copper  and  mica,  giving  it  a  grass- 
green  color.  Autunite,  uranium,  calcium  phosphate,  usually 
are  in  yellow  crystals.  Samarskite,  a  compound  of  the 
oxide  associated  with  columbic  and  tungstic  acid.  Carnotite, 
oxide  of  uranium  associated  with  vanadium. 

Other  rare  forms  are  uranospinite,  uranvitriol,  uranociveite 
and  while  many  other  minerals  such  as  pyomorphite,  con- 
tain more  or  less  radium,  the  source  of  supply  is  entirely 
from  the  silver  uranium-bearing  ores. 

It  is  most  unfortunate  that  so  much  difficulty  exists  in 
the  separation  of  radium  from  the  by-products  with  which 
it  is  so  closely  associated  in  its  native  state  and  in  the  recovery 
of  it  by  these  most  tedious  chemical  processes;  this  fact 
is  particularly  true  in  the  case  of  its  association  with  thorium, 
and  it  has  been  pointed  out,  that  under  some  circumstances 
the  separation  is  impossible.  Thorium,  as  it  will  be  seen, 
disintegrates  rapidly  and  while  undergoing  this  rapid  change 
it  gives  forth  a  very  powerful  radiation.  If,  therefore,  a 
given  preparation  of  radium  has  a  considerable  quantity  of 
thorium  mixed  with  it,  it  would  for  the  time- be  extremely 
active;  however,  in  a  few  years  this  activity  would  cease, 


38  THE  RADIO-ACTIVE  ELEMENTS 

then  the  specimen  would  contain  only  the  radium  radiation. 
The  radium  being  the  most  valuable,  as  its  period  of  life 
is  about  two  thousand  years,  while  the  thorium  is  only 
worth  that  value  for  the  unexpired  radiatory  period. 
Therefore,  in  the  purchase  of  radium,  its  admixture  with 
thorium  should  be  fully  understood. 

THORIUM. 

Thorium  stands  in  its  group  much  the  same  as  uranium 
in  the  radium  group;  it  is  doubtful  if  thorium,  as  a  pure 
element,  gives  off  any  rays,  and  if  so,  they  are  extremely 
feeble  and  belong  to  the  alpha  group. 

Thorium  has  an  atomic  weight  of  232.5.  Its  period  of 
life  is  unknown,  and  is  probably  much  longer  than  that  of 
uranium.  Chemically  it  belongs  to  the  group  of  rare  earths. 
It  is  found  as  thorite  in  the  monazite  sands  of  North  and 
South  Carolina,  in  Brazil,  and  in  Ceylon,  in  combination 
with  other  minerals,  such  as  rutile,  zircon,  in  some  granites 
and  under  most  circumstances  it  is  also  associated  with 
uranium.  Thorium-bearing  minerals  are  more  prone  to  be 
contaminated  with  a  relatively  high  percentage  of  radium, 
than  are  the  radium-bearing  ores  with  thorium,  and  on 
account  of  the  difficulty  of  separating  the  thorium  ele- 
ments from  the  radium  elements,  production  of  the  pure 
thorium  element  at  the  present  time  is  impossible.  It  is 
used  extensively  in  the  arts  and  it  is  refined  by  many  tech- 
nical processes,  one  being  the  heating  of  the  sand  with 
twice  its  weight  of  sulphuric  acid;  the  cold  mass  is  dis- 
solved in  water  and  left  to  settle.  The  solution  is  then 
fractionally  precipitated  with  magnesia,  the  thorium  being 
concentrated  mainly  in  the  first  fractions  precipitated. 


THORIUM  39 

The  most  useful  agent  for  precipitating  thorium  from 
aluminium  and  iron  is  oxalic  acid  with  which  it  forms  a  most 
insoluble  compound.  It  may  be  separated  from  some  of  the 
other  rare  earths  by  its  precipitation  of  dimethylamine. 
Potassium  hydrazoate  precipitates  thorium  hydroxide  in 
the  presence  of  cerium  upon  boiling.  Thorium  forms  a 
compound  with  acetylacetone  Th(C5H-O2)4  which  is  soluble 
in  chloroform  and  alcohol  and  can  be  distilled  in  a  vacuum. 
This  method  is  employed  in  the  purification  of  this  element. 

FIG.  6 


A  radiograph  made  of  a  Welsbach  gas  mantle  by  its  own  radiation. 

Fusion  with  soda  carbonate,  as  is  usual  with  most  refrac- 
tory minerals,  results  here  in  the  formation  of  the  highly 
insoluble  thorium  oxide  ThO2. 

Thorium,  aside  from  its  radio-activity,  has  been  used  in 
medicine  in  the  form  of  oxalate  and  oxide  to  control  vomit- 
ing. Its  action  is  astringent  and  at  the  same  time  somewhat 
irritating;  this  is  particularly  noticeable  in  the  soluble  salts 
which,  when  given  intravenously,  produce  decidedly  toxic 
symptoms  and  even  death.  Solutions  of  the  thorium  salts 
precipitate  proteins,  bleach  and  harden  muscles  and  other 


40  THE  RADIO-ACTIVE  ELEMENTS 

tissues.  And,  while  these  salts  have  no  effect  where  the 
skin  is  unbroken,  cases  of  dermatitis  have  been  reported 
among  workers  in  these  earths  which  perhaps  wrere  due  more 
to  the  radio-activity  than  to  what  is  usually  understood  as 
direct  irritation. 

Thorium  gives  to  steel  a  peculiar  property  of  causing  the 
emission  of  extremely  bright  sparks  when  filed  or  struck 
a  sharp  blow. 

The  fusion  of  the  thorium  compounds  reduces  permanently 
their  radiability.  The  disintegration  product  of  thorium  is 
mesothorium.  On  account  of  the  admixtures  of  radium  with 
thorium,  a^  they  are  found  in  nature,  a  careful  study  of  this 
group  of  elements  has  thus  far  been  impossible;  therefore, 
very  little  is  known  of  their  atomic  conditions;  and,  while 
it  is  possible  to  separate  most  of  the  elements  and  recognize 
them  by  their  peculiarities,  there  seems  to  be  no  way  open 
at  the  present  time  of  obtaining  this  information  until  some 
entirely  new  methods  have  been  devised. 

Mesothorium  1. — Its  period  of  average  life  is  7.9  years,  it 
has  the  characteristics  of  an  alkaline  earth,  is  rayless,  and 
simulates  radium  so  closely  that  it  has  never  been  separated 
from  it.  This  also  applies  when  it  is  in  combination  with 
ionium  or  radiothorium.  They  are  all  identical  in  their 
chemical  natures.  Mesothorium  may  be  separated  from  the 
monazite  sands  by  the  same  methods  employed  in  obtain- 
ing radium  from  pitchblend.  A  small  amount  of  barium  is 
added,  which  is  precipitated  with  sulphuric  acid  and  the 
mesothorium  is  found  in  the  insoluble  material.  The  disin- 
tegration product  of  mesothorium  1  is  mesothorium  2. 

Mesothorium  2,  has  a  period  of  life  of  8.9  hours,  and 
probably  belongs  to  the  class  of  rare  earths.  It  is  easily 
separated  from  its  parent  by  the  addition  of  a  little 


THORIUM  41 

ammonium  hydrate  and,  like  the  precipitation  of  uranium 
X,  requires  a  nucleus  to  which  it  may  cling;  therefore,  it  is 
advisable  to  add  a  small  quantity  of  a  xirconium  salt.  This 
precipitate,  however,  will  contain  also  all  the  radiothorium 
present,  therefore  this  precipitation  from  the  mesothorium 
1,  must  be  continued  at  intervals  of  two  days  each,  until 
most  of  the  radiothorium  has  been  removed.  The  difficulty 
of  separating  these  elements  is  evident  and  illustrates  how 
impracticable  it  would  be  to  separate  them  upon  a  com- 
mercial basis;  therefore,  where  they  are  to  be  employed  in 
medicine,  the  strictest  supervision  is  enjoined. 

Radiation. — The  beta-rays  are  of  moderate  penetrating 
power,  but  are  apparently  heterogeneous,  one-half  being 
absorbed  in  0.34  to  0.18  mm.  thicknesses  of  aluminium.  The 
gamma-rays  are  somewhat  weaker  than  those  given  off  by 
radium  and  compare  largely  with  those  of  uranium;  about 
one-half  will  be  cut  off  by  1  cm.  of  lead.  The  disintegration 
product  of  this  element  is  radiothorium. 

Radiothorium  has  an  average  life-period  of  about  three 
years.  It  resembles  its  parent  and  was  recognized  by  merest 
accident;  its  chemical  properties  being  so  identical  that 
most  careful  physical  procedures  are  required  for  its  rec- 
ognition. It  gives  off  an  alpha-ray  which  penetrates  3.9 
cm.  of  air,  and  its  disintegration  product  is  thorium  X. 
Thorium  X  has  a  period  of  life  of  5.35  days;  it  belongs  to 
the  class  of  alkaline  earths.  If,  after  the  precipitation  of  the 
thorium  with  ammonia,  the  filtrate  is  evaporated  to  dryness 
and  the  excess  of  ammonia  carefully  driven  off,  there 
remains  a  non-volatile  residue,  being  thorium  X.  Under  some 
circumstances  the  products  of  the  emanation  of  thorium, 
and  the  "active  product"  are  likely  to  be  contained  in  the 
thorium  X,  but  if  the  solution  is  kept  in  an  open  vessel 


42  THE  RADIO-ACTIVE  ELEMENTS 

for  two  days,  the  product  of  this  change  will  be  eliminated 
to  a  great  extent. 

Radiation  consists  of  an  alpha-ray  and  possibly  a  feeble 
beta-ray;  the  alpha-ray  has  a  penetration  of  5.7  cm.  in  air. 
The  disintegration  product  is  the  emanation. 

The  emanation  of  thorium  is  a  gas  with  an  extremely 
short  life,  seventy-six  seconds,  its  radio-active  constant  is 
0.0131  (sec.)-1.  It  resembles  the  radium  emanation  in  all 
its  physical  properties,  being  condensed  by  liquid  air, 
absorbed  by  charcoal,  and  does  not  enter  into  chemical 
combination.  It  escapes  freely  from  all  thorium  compounds 
but  not  with  the  same  ratio.  The  best  source  of  the  emana- 
tion is  from  radiothorium.  The  range  of  the  alpha-rays  is 
about  5.5  cm.  in  air.  Its  product  of  disintegration  is  thorium 

A.  With    this    element    thorium   A    begins    the   thorium 
"active  deposit  of  rapid  change."    The  activity  of  thorium  is 
so  rapid  that  but  few  of  its  physical  properties  are  under- 
stood.   The  period  of  average  life  is  0.203  seconds,  and  it  is 
supposed  to  give  off  alpha-rays,  the  speed  of  which  have  not 
been  determined.    This  element  passes  rapidly  into  thorium 

B,  where  the  period  of  life  is  somewhat  longer,  being  about 
15.3  hours,  and  gives  off  beta-rays,  one-half  of  which  are 
absorbed  by  the  thickness  of  0.05  mm.  of  aluminium.    The 
next  disintegration  product  is  thorium  C,  which  like  radium 
seems  to  be  a  double  element  C,  and  C2;  however,  the  latter 
has  not  been  established,  but  there  are  given  off  two  alpha- 
rayswhich  have  a  range  of  5  and  8.6  cm.  in  air.     The  end 
of  this  series  is  thorium  D,  with  an  average  life-period  of  4.5 
minutes  and  a  strong  beta-  and  gamma-radiation.     One-half 
of  the  beta-rays  are  checked  by  a  sheet  of  aluminium  0.44 
mm.  thick,  while  it  requires  a  sheet  of  lead  1.5  c.c.  thick 
to  cut  off  one-half  the  gamma-radiation.     By  more  or  less 


THORIUM 


43 


elaborate  physical  means,  these  elements  of  the  "active 
deposit  of  rapid  change"  may  be  separated,  but  as  some  of 
them  have  an  extremely  short  life,  and  the  whole  group  is 
more  or  less  confused,  it  is  still  only  of  scientific  value  like 
the  radium  group,  the  active  product  need  only  be  con- 


Radiograph.  1,  made  by  5  gm.  thorium  oxide  commercial;  2,  made  by 
5  gm.  thorium  sulphate  commercial;  3,  made  by  5  gm.  thorite;  4,  made 
by  5  gm.  uranium  acetate;  5,  made  by  5  gm.  pitchblend. 


sidered  as  a  whole  and,  in  this  instance,  as  the  emanation 
undergoes  such  a  rapid  change,  it  cannot  be  employed  in 
the  same  manner  as  the  emanation  of  radium. 

Thorium  Commercially. — The  radio-active  portion  of  thorium 
has  been  placed  upon  the  market  as  mesothorium ;  on  account 


44 


THE  RADIO-ACTIVE  ELEMENTS 


of  the  difficulty  in  deriving  a  pure  product  of  anyone  of  the 
different  thorium  elements,  the  activity  is  usually  rated  upon 
that  of  radium.  In  other  words,  radium  element  in  equilib- 
rium is  also  the  standard  for  thorium.  As  it  undergoes  a 
rapid  disintegration,  the  age  of  the  salt  is  most  important. 
While  there  is  considerable  contention  as  to  the  exact  time 
of  life  of  these  thorium  preparations,  the  one  that  appears  to 


YEARS 


* 

no 

100 
90 
80 
70 
80 
60 
40 
JO 
20 
10 

1       234       567       8      9     10     11     12     13     14     15    16     17     18     19    2( 

o 

\ 

> 

V 

\ 

\  

\ 

\ 

> 

\ 

\ 

\ 

v^ 

-\ 

*-*. 

•~  — 



•  —  •  —  , 

• 

• 



Diagram  showing  the  possible  rate  of  decay  of  commercial  mesothorium. 


be  most  accepted  is  that  during  the  first  year  it  gains 
siderably,  then  undergoes  a  rapid  decline,  until,  in  the  fourth 
year,  about  one-half  its  energy  has  been  lost;  this  steadily 
declines,  until  at  the  end  of  the  tenth  year,  all  the 
radiation  from  the  thorium  has  been  dissipated,  and  what- 
ever activity  remains,  is  due  to  radium.  This  disintegration 
curve  has  by  no  means  been  accepted  and  there  are  some 
who  believe  that  it  should  be  extended  to  fifty  years. 


ACTINIUM  45 

There  has  been  an  effort  to  market  the  "active  product" 
of  thorium  disintegration,  under  several  trade  names.  It 
compares  in  its  life  to  a  great  extent  with  the  radium 
emanation,  but  instead  of  being  a  gas,  it  is  a  solution  of  the 
"active  products;"  like  the  radium  emanation  it  undergoes 
a  very  rapid  decay,  and  for  that  reason  it  cannot  be  shipped 
to  a  point  any  great  distance  from  the  laboratory  in  which 
it  is  made.  While  it  is  principally  known  as  thorium  X 
its  activity  is  due  to  the  rapid  disintegration  of  the  elements 
of  the  group  composing  the  "active  deposit."  The  ordinary 
physical  properties  of  mesothorium  are  much  the  same  as 
those  described  under  radium  and  therefore  need  not  be 
repeated. 

ACTINIUM. 

The  Actinium  Group. — The  remaining  group  of  these 
radio-active  elements  is  mentioned  merely  for  contrast; 
while  some  reports  have  been  made  where  it  has  been  em- 
ployed in  medicine,  it  was  purely  in  the  nature  of  scientific 
interest.  It  possesses  all  the  properties  of  the  two  preceding 
groups  and  would  be  equally  useful  as  a  therapeutic  agent, 
if  it  were  possible  to  procure  it  in  sufficient  quantities. 
Actinium  was  discovered  by  Debierne  in  pitchblend;  asso- 
ciated with  the  other  radio-active  elements;  it  takes  its 
place  in  the  iron  group.  Its  nearest  chemical  analogue  seems 
to  be  lanthanum.  The  period  of  average  life  is  unknown  and 
it  appears  to  be  rayless.  Its  parent  is  unknown  and  in 
some  ways  uranium  seems  to  be  associated  with  it  in  this 
respect;  the  difference  in  the  activity  of  uranium  minerals 
and  uranium  favoring  this  supposition.  To  produce  a 
preparation  of  actinium  with  its  products  of  disintegration, 
that  would  compare  with  radium,  requires  ten  or  twelve  times 


46  THE  RADIO-ACTIVE  ELEMENTS 

as  much  mineral  product.  It  has  never  been  procured  in  a 
pure  state  and  is  always  associated  with  lanthanum. 

The  disintegration  product  of  actinium  is  radio-actinium, 
which  has  a  period  of  average  life  of  28.1  days;  it  may  be 
separated  from  its  parent  by  adding  a  little  sodium  thio- 
sulphate  in  a  strongly  acid  solution.  The  acidification  of 
this  sulphate  causes  a  precipitation  of  sulphur  which  car- 
ries down  with  it  the  actinium  X.  Very  little  of  its 
chemical  nature  is  known,  but  it  gives  off  an  alpha-  and 
beta-radiation.  The  range  of  the  a-ray  is  4.55  cm.  in  air 
while  one-half  the  /3-ray  penetrates  a  thickness  of  0.04 
mm.  of  aluminium.  Its  disintegration  product  is  actinium 
X,  which  gives  off  an  a-radiation,  having  a  range  of  4.17  cm. 
in  air.  Chemically  it  compares  with  radium  and  has  a  life- 
period  of  14.8  days.  It  resembles  thorium  X  and  is  sepa- 
rated from  actinium  by  precipitation  with  ammonia,  but 
differs  in  this  respect  that,  when  ignited  to  drive  off  the 
ammonia,  the  active  product  is  also  volatilized,  but  it  imme- 
diately starts  to  produce  a  fresh  supply.  Its  disintegration 
product  is  the  emanation  with  an  average  period  of  life 
of  5.6  seconds.  It  has,  like  the  emanation  of  radium  and 
thorium,  an  alpha-radiation  and  its  disintegration  product 
is  actinium  A. 

Actinium  A  begins  the  list  of  the  "  active  deposit  of  rapid 
change"  exactly  the  same  as  in  the  other  two  series  but  the 
existence  of  this  element  is  extremely  short,  as  the  "  period 
of  average  iife"  is  0.0029  second;  it,  however,  gives  off  an 
alpha-radiation  which  has  a  range  of  6.1  cm.  in  air.  Its 
disintegration  product  is  actinium  B,  with  an  average  period 
of  life  of  fifty-two  minutes  and  gives  off  a  fair  /3-radiation. 
Next  in  order  is  actinium  C,  and  here  again  there  seems  to 
exist  the  same  double  element  as  in  the  two  other  groups, 


ACTINIUM  47 

but  the  same  doubt  exists  here  as  it  does  in  thorium.  Its 
period  of  life  is  about  three  minutes  and  is  followed  by 
actinium  D,  the  end  of  the  series  of  the  active  product. 
This  is  followed  by  actinium  E,  which  like  that  of  the 
thorium  group  is  unknown.  Actinium  D  gives  off  both  a 
beta-  and  gamma-radiation.  Its  period  of  average  life  is  7.5 
minutes,  while  the  actinium  group  follows  in  order,  exactly 
the  same  as  the  other  two ;  the  beginning  and  the  end  still 
remain  unknown. 

The  present  knowledge  of  these  series  of  disintegration 
has  been  gained  from  uranium  and  radium  which,  by  a 
careful  technique,  can  be  obtained  in  the  pure  state.  This  is 
not  true,  however,  with  regard  to  thorium  and  actinium, 
which  so  far  have  not  been  separated  in  a  condition  pure 
enough  to  obtain  such  details  as  their  atomic  weights  or 
their  spectra.  It  should  also  be  remembered  that  most  of 
these  radio-active  salts  upon  the  market,  contain  more  or 
less  of  all  these  elements  which,  in  the  case  of  radium,  is 
usually  so  small  as  not  to  be  detectable.  Where  the  radium 
is  to  be  used  for  such  purposes  as  the  study  of  the  spectrum, 
the  "active  products"  and  gases  from  thorium  and  actinium 
degenerate  so  rapidly  that  they  offer  very  little  interference. 
While,  on  the  other  hand,  with  thorium  there  is  usually 
a  fairly  high  percentage  of  radium  associated,  this  in  no 
way  interfering  with  their  therapeutic  value,  and  after  the 
period  of  disintegration,  which  is  rather  short,  from  twenty 
to  thirty  years,  the  specimen  still  contains  some  activity. 


CHAPTER  III. 
RADIO-ACTIVITY. 

Definition — -The  Alpha-ray— The  Beta-ray — The  Gamma-ray — Helium — 
Comparison  of  the  a-,  /8-  and  }-rays  with  the  rays  generated  in  a  Crookes 
Tube — Equilibrium — Period  of  Life — lonization — Properties  Causing  Fluo- 
rescence— Phosphorescence— Heat  and  Other  Physical  Phenomena. 

A  DEFINITION  given  to  this  new  department  of  science, 
radio-activity,  is,  "The  dynamic  property  found  in  certain 
bodies  of  high  atomic  weight,  of  spontaneously  emitting 
peculiar  and  characteristic  rays,  invisible  to  the  eye,  and 
capable  of  penetrating  objects  opaque  to  ordinary  light" 
(Standard  Dictionary).  While  this  definition  partly  defines 
the  word,  it  in  some  way  promotes  confusion  as  to  the 
quality  of  these  rays.  A  clear,  concise  definition  has  as 
yet  not  been  given,  but  it  might  be  expressed  as  the  phe- 
nomenon observed  in  the  interchange  of  the  component 
particles  of  the  atoms,  simultaneous  with  their  rearrange- 
ment and  formation  of  new  atoms.  During  this  disturbance 
small  portions  are  projected  from  the  mass,  giving  rise  to 
so-called  rays;  these  rays  in  no  way  resemble  ordinary  light. 

Most  of  the  radio-active  elements  which  are  known  today 
belong  to  a  class  with  a  very  high  atomic  weight;  there 
exists  an  instability  of  their  atoms,  which  are  constantly 
changing  their  nature,  producing,  in  other  words,  other 
elements.  For  instance  uranium,  with  an  atomic  weight  of 
238,  splits  off  an  a-particle  which  forms  an  atom  of  helium, 
with  the  atomic  weight  of  4,  leaving  uranium  II  the  second 


RADIO-ACTIVITY  49 

product,  with  the  atomic  weight  of  234.     An  interesting 
experiment  shows  that    when   the   alpha-ray  is  projected 
through  a  tube  with  thin  walls,  helium  is  formed  upon  the 
outside  of  that  tube;  but  if  helium  is  placed  in  the  same 
tube  as  helium,  none  escapes.    Again  if  the  tube  is  incased 
in  lead,  the  a-ray,  being  liberated  from  the  inside,  strikes 
against  these  walls  of  lead  where 
it  is  absorbed.     If   now  the  lead 
is  melted    in   vacuum,  helium  is  (D  ALPHA  PART1CLE 

VV     HELIUM 

liberated  from  the  lead.  // 

In    this    interchange    a  certain  /^    ~N 

amount  of  disturbance  has  taken  (    238    ) 

place,    with  the  manifestation  of  ^* — 

URANIUM  ,ji>«i-.iui.i  .. 

energy,   exactly   the   same   as    in 

...     Showing    the   relation  of    the 
Some  Ot  the  more  common  physical        alpha-particle  and  helium. 

processes  such  as  combustion,  and 

strange  as  it  may  seem,  the  amount  of  energy  given  off  as 
heat  is  many  times  greater,  but  being  eliminated  so  gradually 
over  a  space  of  many  years,  reaching  up  into  the  millions,  it 
is  not  perceptible  to  ordinary  methods  of  observation.  If  the 
energy  given  off  in  this  change  that  is  constantly  occurring 
in  uranium,  could  be  burnt  as  coal,  the  heat  supplied  by 
one  gram,  or  fifteen  grains,  would  be  sufficient  to  produce 
enough  steam  for  a  locomotive  to  pull  a  train  of  cars  to 
Mars  and  back  again. 

During  this  process  of  the  transmutation  of  these  elements 
there  are  three  distinct  sets  of  rays  to  be  observed;  known  as 
a  (alpha),  0  (beta)  and  7  (gamma),  after  the  first  three 
letters  of  the  Greek  alphabet,  and  they  differ  as  widely  in 
their  physical  nature  as  they  do  in  their  therapeutic  effect. 

The  alpha  particle,  or  a-ray  is  a  particle  of  matter  one-fourth 
the  size  of  a  hydrogen  atom  and  discharged  from  the  mass  at 
4 


50 


RADIO-ACTIVITY 


one-tenth  to  one-twentieth  the  velocity  of  light;  these  par- 
ticles are  positively  charged  and  feebly  deflected  by  the  mag- 
net. There  seem  to  be  four  or  more  distinct  groups,  and  those 
given  off  by  uranium  differ  from  those  emitted  from  radium ; 


FIG.  10 


Spinthariscope  of  Sir  William  Crookes. 

these  in  turn  from  those  of  thorium, 
depending  to  a  great  extent  upon 
the  speed  by  which  they  leave  the 
mass.  One  milligram  of  radium 
gives  off  136,000,000  alpha-particles 
per  second.  They  are  expelled  from 
the  radio-active  element  much  as 
bullets  shot  from  myriads  of  little 
guns.  The  projection  of  these  par- 
ticles may  be  shown  by  a  small 
Sir  William  Crookes  and  called  by 
constructed  from  a  lens,  a  screen 
blend)  zinc  sulphide,  and  a  needle 


Diagram  of  spinthariscope. 
An  infinitesimal  amount  of 
radium  is  held  by  a  needle 
(c)  over  a  screen  of  zinc  sul- 
phide (s).  The  lens  (I)  is 
mounted  so  as  to  focus  upon 
the  screen;  inside  of  box 
should  be  black. 


instrument  devised  by 
him  the  spinthariscope ; 
of  (Sadot's  hexagonal 
or  some  other  object, 


RADIO-ACTIVITY 


51 


FIG.  11 


with  an  infinitesimal  amount  of  radium  upon  it.  If  the 
radio-active  salt  is  too  strong,  instead  of  seeing  the  indi- 
vidual sparks,  the  bombardment  will  be  so  rapid  that  a 
continuous  glow  will  result.  As  each  particle  strikes  upon 
the  screen,  there  appears  a  bright  momentary  flash  of 
small  sparks  or  scintillations,  like  a  diminutive  piece  of 
hot  iron  being  hammered  upon  a  small  anvil,  or  myriads 
of  shooting  stars.  With  this  form  of  apparatus  and  more 
refined  technique,  it  is  possible 
to  count  the  number  of  particles 
given  off  by  any  of  these  radio- 
active elements.  From  this 
constant  bombardment  the 
screen  of  zinc  sulphide  be- 
comes in  time  worn  out  or,  in 
other  words,  undergoes  a  fatigue, 
and  the  scintillations  are  by 
no  means  so  bright  or  numerous 
in  an  old  screen  as  in  one  that 
has  been  freshly  prepared. 

While  these  bodies  move  with 
the  velocity  of  about  one-tenth 
that  of  light,  they  possess  little 
power  of  penetration,  most  of 
them  being  entirely  cut  off  by  a 

thin  sheet  of  tissue  paper.  Usually  one  element  gives  off  only 
one  type  of  alpha-rays;  however,  under  ordinary  conditions, 
several  of  these  elements  are  found  together,  due  to  the 
disintegration  of  the  parent.  There  will  be  found,  emitted 
from  a  particle  of  salt,  several  of  these  alpha-rays,  differing 
in  their  penetrating  power,  usually  measured  by  their  range 
in  air.  The  strongest  are  usually  completely  blocked  in  a 


Apparatus  to  show  the  range 
of  the  a-radiation  at  different  air 
pressures.  The  inside  of  the 
glass  globe  is  coated  with  zinc 
sulphide  and  upon  a  is  placed 
a  small  amount  of  radium;  the 
tube  b  is  attached  to  an  air  pump. 


52 


RADIO-ACTIVITY 
FIG.  12 


Apparatus  for  finding  the  range  of  the  a-ray.  The  radium  is  placed  in  a 
very  thin  layer  on  a  platinum  plate  (R,  R).  Over  this  stands  a  bundle  on 
about  150  upright  tubes  (T,  T)  made  of  thin  copper,  each  1  cm.  long  and  2 
mm.  in  diameter.  Only  such  a-particles  emerge  from  these  tubes  as  leave 
the  plate  in  an  almost  vertical  direction.  The  ionization  chamber  is  the  space 
between  the  plate  (Q,  Q)  and  the  parallel  sheet  of  gauze  (g,  g).  It  is  3  mm. 
in  depth  and  its  diameter  is  such  that  the  whole  of  the  a-ray  stream  eiiters 
the  chamber.  The  gauze  is  carried  on  three  glass  pillars,  one  of  which  is 
perforated  along  its  axis  to  allow  electrical  communication  between  the 
gauze  and  the  battery.  The  pillar  which  supports  the  plate  (Q,  Q)  passes 
through  a  glass  plate  made  air-tight  by  india-rubber  washers.  The  plate 
(Q,  Q)  is  connected  to  an  electrometer  and  the  gauze  (g,  g)  to  the  battery, 
so  that  the  gauze  is  at  a  high  potential  compared  with  the  plate,  which  is 
earthed  through  the  electrometer.  The  case  of  the  instrument  is  grounded 


RADIO-ACTIVITY  53 

space  of  6  cm.;  this  range,  of  course,  is  under  normal  atmos- 
pheric conditions,  and  this  is  well  illustrated  by  having  a  flask 
covered  on  the  inside  with  a  film  of  zinc  sulphide;  in  the 
centre  is  a  small  needle,  the  point  containing  a  small  amount 
of  radium  (it  being  understood  that  from  the  point  where 
the  radium  is  suspended  the  radius  is  considerably  more 
than  6  cm.).  Under  ordinary  atmospheric  conditions  nothing 
is  observed,  but  as  soon  as  this  flask  is  exhausted  to  some 
extent,  causing  the  air  to  become  rarefied,  the  alpha-particles, 
meeting  with  less  obstruction,  impinge  upon  the  crystals  of 
zinc  sulphide  and  cause  them  to  glow  in  the  same  manner 
as  when  they  were  within  range  under  normal  conditions. 
The  path  of  these  rays  and  their  speed  have  been  studied 
by  a  similar  method,  so  arranged  that,  as  these  particles 
travel  through  dust  of  this  material,  during  their  flight  they 
are  photographed  and  timed  by  comparison  with  electric 


permanently,  so  that  no  electricity  can  pass  over  from  the  battery  to  the 
electrometer.  In  order  to  prevent  accidental  and  troublesome  electro- 
static effects,  the  interior  is  so  arranged  that  no  lines  of  force  end  on  Q,  Q, 
but  only  such  as  have  proceeded  from  metal  surfaces  of  definite  and  unalter- 
ing  potential.  For  this  purpose  glass  pillars  which  support  g,  g  are  buried  in 
cavities  in  the  body  of  the  case;  if  there  should  be  any  leakage  over  the 
pillars,  there  cannot  be  any  resulting  electrostatic  action  on  the  plate  (Q,  Q). 
The  gauze  sheet  (g',  g')  is  grounded,  and  is  placed  as  far  below  the  gauze  (g,  g) 
as  the  plate  (Q,  Q)  is  above  it;  thus  the  electrical  field  is  made  symmetrical, 
and  no  ions  from  below  can  make  their  way  into  the  chamber,  as  it  must  be 
remembered  that  there  is  heavy  ionization  below  the  gauze,  that  must  not 
contribute  to  the  current  measured.  A  screen  (s,  s)  of  very  thin  copper  is 
mounted  on  a  rod  which  passes  into  the  apparatus  through  a  stuffing  box,  and 
can  be  raised,  lowered,  and  turned  around.  The  screen  can  be  used  to  cut  off 
all  the  a-radiation  from  the  radium,  or  can  be  turned  aside  when  it  is  desired 
to  allow  these  rays  through  the  above  screens  for  measurement.  The  case 
of  the  apparatus  is  made  in  two  parts,  the  upper  one  carrying  the  gauzes 
and  ionization  chamber.  The  tubes  A,  B,  and  C,  are  for  the  purpose  of 
filling  the  case  with  any  desired  gas  or  vapor.  The  whole  apparatus  is 
surrounded  by  an  outer  case  (D,  E,  F,  G),  and  the  joints  in  this  case  must  be 
protected  in  the  same  manner  as  those  in  the  inner  case,  particularly  when 
the  radiation  of  a  gas  is  to  be  studied. 


54  RADIO-ACTIVITY 

flashes.     The  range  of  the  alpha-particle  is  proportionate 
to  a  third  of  its  velocity.    There  is  some  doubt  as  to  whether 
the  alpha-ray  itself  possesses  the  power  of  ionization,  or  - 
whether  it  is  due  to  the  formation  of  secondary  rays  of 
another  variety. 

The  beta  (0)  ray  is  an  electron  or  a  small  particle  charged 
with  negative  electricity  moving  with  almost  the  same 
velocity  as  light.  It  would  require  about  4000  beta-particles 
to  balance  one  alpha-particle,  as  the  mass  of  an  electron  is 
equal  to  TT5Vo  Par^  °f  a  hydrogen  atom;  but,  small  as  they 
are,  they  cause  more  or  less  disturbance  in  the  matter  through 
which  they  pass.  The  effect  of  gravity  upon  these  particles  is 
still  unknown.  Electrons  have  been  spoken  of  as  being  dis- 
turbances in  ether;  they  were  first  observed  by  Sir  William 
Crookes  as  the  cathode  rays  and  given  the  name  of  "radiant 
matter."  They  are  not  homogeneous,  varying  in  most  part 
from  40  per  cent,  to  80  per  cent.,  and  are,  for  practical  pur- 
poses, arbitrarily  divided  into  soft,  medium,  and  hard  rays. 
The  hard  rays  are  of  extreme  tenacity  and  it  is  doubtful  if 
1  cm.  of  lead  will  completely  block  them.  They  all  ionize 
the  gas  through  which  they  pass,  leaving  a  column  of  ions 
in  their  tracks.  The  magnet  causes  them  to  be  turned  in  their 
path  clockwise;  consequently  they  are  deviated  to  the  north 
pole. 

The  cathode  ray  and  the  beta-particle  carry  the  same 
electrical  charge  as  the  hydrogen  atom.  They  are,  in 
other  words,  atoms  with  the  mass  removed.  The  cathode 
ray  travels  with  a  velocity  of  about  5000  to  10,000  miles 
per  second  while  the  beta-particle  travels  many  times 
faster;  the  highest  will  approach  185,000  miles  per  second. 
The  speed  with  which  the  beta-particles  are  projected  from 
these  radio-active  elements  varies  with  each  one,  and  here 


RADIO-ACTIVITY 


55 


FIG   13 


again,  under  the  ordinary  circumstances  of  any  salt  con- 
taining the  products  of  disintegration,  there  will  be  a  wide 
variation  of  all  the  beta-rays. 

The  discharge  of  these  beta-rays  from  the  radio-active 
salts  gives  rise  to  many  curious  experiments,  one  of  which 
is  illustrated  by  what  is  known  as 
Professor  Strutt's  radium  clock 
which  works  by  the  continuous 
charge  and  discharge  of  these 
beta-rays.  It  is  constructed  by 
placing  a  small  glass-  tube,  con- 
taining radium,  suspended  by 
some  insulating  material,  in  a 
glass  flask,  which  is  exhausted 
to  a  vacuum  of  high  degree.  At 
the  lower  end  of  the  radium  tube 
two  sheets  of  gold  leaf  are  hung, 
which  act  as  an  electroscope. 
As  the  beta-rays  are  shot  away 
from  the  radium,  carrying  their 
negative  electricity,  they  leave 
behind  the  positive  charge,  which 
gradually  accumulates  until  the 
leaves  of  the  electroscope  touch 
the  sides  of  the  flask,  discharge 

the     electricitv    of   the   mass   of        Prof.  Strutt's  clock:    b,  tube 
AW  of    radium;    c,    gold    leaf;    a, 

radium,  and  collapse;  they   then    quartz  thread  insulator. 
gradually  expand   again,  as  the 

charge  accumulates  until  they  are  again  discharged.  This 
continues  indefinitely  and  with  utmost  precision,  the  rate 
being  in  proportion  to  the  discharge  of  the  mass  of  radium 
contained  within  the  small  tube. 


56  RADIO-ACTIVITY 

The  gamma  (7)  rays  have  been  described  as  pulsations 
of  ether  of  extremely  short  wave  length,  or  a  secondary 
electro-magnetic  disturbance  of  ether  due  to  the  motion  of 
the  beta-rays;  however  very  little  is  known  about  them. 
At  one  time  they  were  thought  to  be  secondary  pulsations 
to  the  beta-ray,  but  it  is  now  known  that  secondary  beta- 
rays  are  formed  along  the  path  of  the  gamma-ray,  and  it 
was  also  inferred  that  where  the  beta-ray  was  given  off  it 
was  also  accompanied  by  the  gamma-ray.  These  views 
are  all  more  or  less  confused  as  they  depend  upon  each  other. 
The  gamma-rays  might  be  compared  to  the  high  axrays, 
and  simulate  them  in  many  of  their  physical  properties. 
They  have  the  same  velocity  as  light  and  are  not  deflected 
from  their  path  by  any  agent  so  far  known.  They  are  not 
polarized,  nor  has  the  magnet  any  effect  upon  them.  Their 
power  of  penetration  is  extreme,  passing  through  many  cen- 
timeters of  lead,  and  they  are  practically  only  annihilated 
by  space. 

The  ultraviolet  rays  ranging  above  the  high  end  of  the 
spectrum  are  often  confused  with  these  rays  but  have  abso- 
lutely nothing  in  common  with  them,  therefore  the  ordinary 
light  rays,  with  the  infra  reds  and  ultraviolet  that  differ  so 
widely  in  their  physical  characteristics,  must  be  considered 
under  an  entirely  different  classification. 

While  the  alpha-,  beta-,  and  gamma-rays  have  their 
individual,  physical  properties,  there  are  some  which  they 
all  seem  to  have  in  common,  and  even  with  the  other  different 
rays  observed  in  and  about  an  x-ray  or  Crookes  tube.  It  has 
just  been  mentioned  that  the  gamma-rays  compare  with 
high  z-rays,  and  that  the  cathode  rays  are  analogous  to 
the  beta-rays;  while  the  alpha-rays  compare  with  the  canal 
rays;  the  difference  always  being  that  the  rays  given  off 


RADIO-ACTIVITY  57 

by  these  radio-active  elements  are  invariably  of  higher 
velocity  than  those  from  an  artificial  source.  This  is  the 
essential  difference  between  the  use  of  .r-rays,  from  artifi- 
cial sources,  and  the  rays  derived  from  nature's  laboratory; 
as  to  their  other  physical  properties  they  resemble  each 
other,  if  they  are  not  identical;  one  of  the  most  interesting 
of  them  being  the  deviation  of  the  cathode  ray  from  its 
path  by  the  magnet,  exactly  in  the  same  direction  as  the 
beta-ray. 

FIG.  14 


c,  c,  canal  rays  analogous  to  the  alpha-rays  observed  back  of  the  cathode ; 
C,  R,  the  cathode  ray  analogous  to  beta-rays,  passing  between  the  cathode 
and  the  point  of  the  anode;  x,  x,  x-ray  analogous  to  the  gamma-ray, 
formed  at  a  point  upon  the  anode. 


All  these  rays  have  the  effect  of  reducing  the  silver  of 
photographic  plates  and  producing  radiographs;  however, 
it  will  be  noticed  that  radiographs  made  from  radio-active 
salts  always  lack  the  definition  of  those  made  by  the 
Roentgen  rays.  This  is  due  doubtless  to  the  secondary 
radiation  which  is  more  prevalent,  not  only  from  surround- 


58  RADIO-ACTIVITY 

ing  objects  of  a  material  nature  but  also  from  smaller  objects, 
such  as  microscopic  dust,  that  ordinarily  are  not  taken  into 
consideration.  If  by  means  of  a  magnet  the  /3-radiation  is 
turned  aside,  the  radiograph  will  have  much  sharper  outlines, 
while  removing  it  by  filtration  has  not  the  same  effect. 

Secondary  radiation,  from  a  medical  stand-point,  requires 
more  consideration  when  these  radio-active  salts  are  used 
than  would  be  necessary  with  the  Roentgen  rays.  The 
cause  seems  to  be  principally  due  to  the  /3-radiation  which  is 
always  so  extremely  active. 

The  penetrability  of  these  rays,  Rutherford  has  placed  at 
the  following  values :  a  =  l  |8  =  100  and  /'  =  1000;  they,  how- 
ever, overlap  to  some  degree,  in  other  words,  the  most  pene- 
trating alpha-ray  passes  beyond  the  soft  beta,  while  the 
hard  beta  passes  beyond  the  soft  gamma. 

Absorption  of  J^  by 

thickness  of 
Ionizing  power.  Penetration.  aluminium. 

a 10,000  1  0.005 

/3   .....          100  100  0.5 

y  ......  1  10,000  80.0 

The  amount  of  radiation  eliminated  by  radium  in  equili- 
brium is  principally  in  the  form  of  the  alpha-ray  and  it 
exceeds  both  the  beta  and  gamma;  the  amount  of  beta 
radiation  is  far  in  excess  of  the  gamma ;  therefore  the  gamma 
radiation,  which  is  so  desirable  in  medicine,  is  given  off  in 
such  small  quantities  that,  from  an  experimental  stand- 
point, it  hardly  needs  to  be  considered.  The  proportion 
between  the  a-  and  /'-rays  is  illustrated  by  the  fact  that 
the  alpha-rays,  forming  1  mg.  of  radium,  more  than  equal 
the  gamma-radiation  of  136  mg.;  therefore  it  is  easily  seen 
why  such  enormous  quantities  of  this  material  are  used  in 


RADIO-ACTIVITY 


59 


the  treatment  of  disease;  where  the  a-  and  /3-rays  must  be 
removed  by  filtration. 


FIG.  15 


{3ANNAL  RA 
ALPHA  RAY 
^CATHO 
I^EETA  I 

r  x  R 

|  GAMMA 


AYS 
AYS 

CATHODE  RAYS 
BETA  RAYS 
RAYS 
A  RAYS 


Showing  the  penetration  of  the  different  rays. 

Equilibrium  of  these  radio-active  elements  is  that  cycle 
or  continuation  of  them,  when  the  processes  of  disintegration 
have  become  balanced  and  the  amount  of  radiation  from 
the  salts  becomes  more  or  less  continuous  at  a  given  ratio. 
When  fresh  salts  of  radium,  thorium  or  any  of  the  other 
elements  are  freshly  crystallized,  the  new  material  is  only 
very  feeble  or  entirely  lacking  in  its  radio-activity.  As 
these  crystals  age  (perhaps  the  aging  is  only  the  matter 
of  a  portion  of  a  second,  or  it  may  be  many  years)  up  to 
a  given  point  they  gain  in  activity.  This  process  is 
continued  until  the  rate  of  decay  of  its  final  disintegrating 
element  becomes  balanced;  then  the  whole  salt  is  in 
equilibrium.  If,  for  some  reason,  the  crystals  are  re-crys- 
tallized before  they  reach  the  stage  of  equilibrium  it  in 
no  way  influences  the  new  cycle,  in  other  words  the  stage 
of  gaining  equilibrium  begins  with  the  age  of  the  crystals 
and  with  that  alone.  To  illustrate:  let  Z,  a  salt  in  equi- 
librium (e)  be  composed  of  5  per  cent,  of  A  that  requires 
one  day  to  form  in  full  amount;  B  10  per  cent,  within  two 
days  after  A ;  C  10  per  cent,  within  ten  days  after  B,  and  so 


60  RADIO-ACTIVITY 

on.  The  salt  Z,  when  one  day  old,  would  only  give  off  5 
per  cent,  of  radiation;  at  the  end  of  five  more  days  it  wrould 
have  gained  the  10  per  cent.  B  force  and  some  from  C, 
making  possibly  between  18  and  20  per  cent.,  depending  upon 
the  rate  of  formation  of  C.  Most  of  these  radio-active 
elements  gain  their  greatest  amount  of  radiation  in  the  first 
half  of  their  average  period  of  life.  This  gaining  process, 
therefore,  would  be  continued  until  the  last  disintegrating 
element  of  that  series  had  gained  its  balance,  and  the  full 
salt  would  be  in  "equilibrium;"  in  other  words,  it  is  the 
point  of  radio-active  saturation  where  the  process  of  gain 
on  the  one  hand  equals  the  decay  on  the  other.  Most  of 
the  radio-active  elements  used  in  medicine  gain  their  equi- 
librium in  a  comparatively  short  space  of  time;  otherwise 
the  activity  would  not  be  sufficient  for  therapeutic  purposes ; 
for  instance,  the  slow  change  of  uranium  and  the  rapid 
change  in  radium.  The  latter  gains  most  of  its  activity  in 
about  a  month,  and,  while  it  gains  a  little  more  after  the 
lapse  of  twenty-four  years,  it  is  rather  feeble,  and  from  a 
therapeutic  stand-point  is  not  worth  considering. 

TABLE  SHOWING  THE  GAIN  OF  RADIATION  DURING  THE  DIFFERENT  PERIODS. 

Alpha  particles.  /3-  and  y-rays. 

I.  Freshly  prepared.    1.  Due  to  pure  radium.  None. 

(First  period.) 

II.  After  thirty  days.    4.  Due  to  radium  emanation.  2.  "Active  deposit  of 

(Second  period.)             Radium  A,  Radium  C.  rapid  change." 

III.  After  a  century.      5.  Same  as  second  period  and  3.  One     added     by 

(Third  period.)               one  added  by  Radium  F.  Radium  E. 

The  "average  period  of  life"  is  a  term  used  to  express  the 
time  of  existence  of  an  atom  of  any  one  of  these  radio-active 
elements.  In  some  this  existence  is  extremely  short,  even 
the  fraction  of  a  second,  while,  on  the  other  hand,  it  may 
extend  over  1,000,000  years.  This  relates  to  the  future  life 
of  the  atoms,  does  not  consider  the  past,  and  is  merely 


RADIO-ACTIVITY  61 

the  sum  of  separate  periods  of  future  existence.    It  may  be 
expressed  by  the  following  equation: 

it 


Where  /o  is  the  initial  activity  It,  the  activity  after  any 
time  t,  X  a  constant  known  as  the  radio-active  constant, 
and  e  the  number  2,71828  in  the  case  of  polonium. 

It  appears,  however,  that  when  these  elements  first  form 
the  disintegration  varies.  These  atoms  may  change  in  a 
shorter  space  of  time,  but  the  "period  of  half  change"  is 
by  no  means  used  to  express  half  of  the  average  period 
of  life;  insofar  as  time  is  concerned  it  may  be  almost  as 
long  as  the  average  period  of  life.  These  terms  must  not 
be  confused  with  the  practical  application  of  the  elements. 
An  example  of  this  is  illustrated  by  the  life  of  the  radium 
emanation,  which  has  a  period  of  average  life  of  5.57  days. 
Period  of  half  change  is  3.86  days,  which  might  seem  to 
imply  that  when  the  emanation  was  removed  from  the 
radium  in  5.57  days  its  usefulness  would  cease,  but  it  must 
be  remembered  that  at  the  time  there  are  atoms  of  all  ages 
present  and  added  to  this  are  the  various  periods  of  average 
life  of  other  products  included  in  the  "active  deposit  of 
rapid  change,"  and  therefore  the  curve  of  disintegration, 
insofar  as  its  practical  application  is  concerned,  is  decidedly 
altered,  and  follows  that  given  in  Fig.  16,  page  62.  When 
radium  emanation  is  separated  from  its  parent  it  has  gained 
its  equilibrium  in  three  or  four  hours;  in  four  days  it  has 
degenerated  to  one-half  its  full  value,  and  from  here  on  the 
process  is  somewhat  slow,  but  at  the  end  of  fifteen  days  its 
radiation  has  practically  disappeared. 

Therefore  the  change  in  a  single  atom  of  one  of  these 


62 


RADIO-ACTIVITY 


radio-active  elements  must  not  be  confused  with  the  disin- 
tegration mass  of  a  whole  series. 

FIG.  16 


H 

r 

jj 

(go 

B 

T 

A 

G 

Apparatus  for  estimation  of  radio-activity:  A,  ionizing  chamber;  B,  elec- 
troscope or  electrometer;  C,  changing  apparatus;  D,  condenser. 

The  rate  of  change  in  any  single  case  of  atomic  disinte- 
gration is  proportionate  to  the  quantity  of  the  substance 
which  is  changing.  By  determining  the  different  factors 
an  algebraic  proportion  may  determine  these  facts;  but 
before  reaching  the  factor  for  solving  this  problem  "the 
radio-active  constant"  must  be  established  which  signifies 
the  amount  of  that  mass  which  undergoes  change  in  one 
second,  and  in  the  case  of  radium  emanation  is  ^grVro 
of  the  total.  For  the  consideration  of  this  "constant" 
the  change  of  these  elements  must  be  considered  at  different 


RADIO-ACTIVITY  63 

periods  of  their  lives,  as  atoms  disintegrating  first  have  a 
much  shorter  period  of  life,  while  those  in  the  latter  part 
of  the  decay  have  a  much  longer  period  than  the  average. 

lonization. — One  of  the  most  important  properties  possessed 
by  these  radio-active  elements  is  the  ionization  of  gases  by 
their  radiation.  This  phenomenon  is  manifested  by  the 
discharge  of  electrified  bodies,  either  positively  or  negatively 
charged,  and  is  the  basis  of  all  analytical  analysis  in  the  study 
of  radiation. 

The  general  supposition  is  that  the  process  of  the  ioniza- 
tion in  gases  is  due  to  the  removal  of  a  negative  corpuscle 
or  electron  from  a  molecule  of  gas;  the  electron  becomes 
attached  to  another  molecule  and  becomes  a  negative  ion. 
The  molecule  from  which  this  negative  corpuscle  was 
removed  retains  its  positive  charge. 

The  amount  of  current  needed  to  balance  the  ionization 
of  a  given  mass  is  known  as  the  current  of  "saturation," 
the  variation  depends  upon  the  velocity  of  the  ions  and 
their  state  of  re-combination.  The  negative  ions  are  decidedly 
more  active  than  positive  ions,  the  former  causing  particles 
of  water  or  organic  vapors  to  collect  about  them  while  the 
latter  act  only  to  a  very  limited  extent;  from  this  phenome- 
non it  has  been  possible  to  calculate  the  charge  of  the  ions. 

The  a-rays  produce  from  2000  to  6000  ions  per  millimeter 
of  path,  while  the  (S-rays  produce  not  more  than  20  to 
30  per  millimeter.  It  has  been  supposed  that  ionization  is 
principally  due  to  the  /3-rays  or  to  secondary  /3-radiation, 
formed  by  either  the  a-  or  7-rays;  this,  however,  is  open  to 
objection  and  possibly  the  ionization  may  be  directly  from 
either  source  of  radiation. 

Properties  Causing  Fluorescence  and  Phosphorescence.— 
The  rays  given  oft'  by  these  radio-active  elements  have  the 


64  RADIO-ACTIVITY 

remarkable  power  of  causing  certain  substances,  chemical 
salts  and  minerals,  to  emit  light;  some  only  while  the  rays 
impinge  upon  them,  which  has  been  termed  fluorescence; 
and  others  continuing  to  glow  for  a  time  after  their  ex- 
posure, this  being  termed  phosphorescence.  The  rays  have 
by  no  means  an  equal  action  upon  the  same  or  different 
minerals  or  chemical  salts:  some  will  glow  under  the  influ- 
ence of  the  alpha-ray  that  fail  to  respond  to  the  beta-ray, 
and  even  while  the  x-ray  and  the  7-ray  are  almost  identical, 
in  some  of  these  substances  the  light  emitted  by  them 
differs  to  a  considerable  degree. 

The  action  of  the  a-ray  upon  Sadot's  hexagonal  blend 
zinc  sulphide,  has  been  previously  explained;  the  others, 
/8-,  7-,  or  x-rays,  fail  to  excite  it  in  any  such  degree,  with 
the  peculiar  individuality  which  has  been  described. 

Willemite  (zinc  silicate)  and  platino-barium-cyanide, 
become  most  brilliant  under  the  influence  of  the  /3-  and  7- 
rays,  as  well  as  the  x-rays,  but  magnesium-platinum-cyanide 
responds  brilliantly  to  the  x-rays,  but  not  to  either  the  /3- 
or  7-ray s.  The  artificial  zinc  silicate  does  not  possess  these 
fluorescent  properties.  By  the  use  of  these  different  articles 
it  is  possible  to  have  brilliant  light  produced  by  the  different 
rays  and  in  this  way  to  separate  them  to  some  extent. 

There  are  many  other  substances,  such  as  most  natural 
crystals,  the  diamond,  emerald,  calcite,  gypsum  apatite,  also 
the  aniline  dyes,  quinine,  metol,  and  a  wide  range  of  other 
organic  chemicals,  which  become  fluorescent  and  some  of 
them  phosphorescent  under  the  influence  of  these  rays. 

The  color  of  this  fluorescence  may  vary  from  a  bright 
yellow  to  deep  orange,  and  some  will  even  show  a  dull  red. 
Others,  like  the  scheelite  (tungstate  of  calcium),  have  a 
more  bluish  cast.  As  a  general  rule  most  of  these  substances, 


RADIO-ACTIVITY  65 

especially  the  more  brilliant  ones,  glow  with  a  peculiar  bright 
opalescent  canary-yellow  color.  It  would  be  extremely  diffi- 
cult to  draw  a  line  between  the  fluorescent  and  the  phos- 
phorescent substances,  for  in  most  instances  those  that  are 
fluorescent  have  what  is  technically  spoken  of  as  a  "lag;" 
that  is,  the  light  does  not  disappear  with  the  cessation  of  the 
exciting  cause,  in  other  words,  they  are  slightly  phosphor- 
escent. Here  again  we  notice  a  difference  between  the  rays 
which  cause  the  effect.  The  beautiful  effect  of  the  alpha- 
ray  upon  zinc  sulphide  is  lost  if  the  rays  impinging  upon 
it  are  too  numerous ;  or,  if  there  be  too  many  /3-  and  7-rays, 
the  screen  becomes  phosphorescent  and  remains  so  for  some 
time  afterward.  This  is  also  noticed  with  scheelite,  when 
exposed  to  any  of  these  rays,  while  some  of  the  substances 
retain  phosphorescence  for  days. 

The  action  of  these  minerals  and  chemicals  must  not  be 
confused  with  the  natural  luminosity  of  many  of  these 
radio-active  elements,  for  some  of  them  are  extremely 
brilliant  in  the  dark;  even  the  emanation,  when  concen- 
trated, has  quite  a  bright  glow. 

Wherever  a  chemical  or  physical  change  takes  place,  it  is 
well  known  that  it  is  always  accompanied  with  some  dis- 
turbance in  the  element  of  heat;  in  other  words,  heat  is 
given  off,  or  else  there  is  an  absence  of  heat,  which  causes 
the  object  to  become  what  is  commonly  known  as  cold. 
This  disturbance  in  the  disintegration  of  these  elements 
is  manifested  as  heat.  For  instance,  the  amount  of  heat  for 
1  gram  of  pure  radium  is  about  133  calories  per  hour;  this 
becomes  1,160,000  calories  in  one  year,  which  continues 
for  the  life  of  radium,  which  is  2500  years;  and,  therefore, 
the  total  disintegration  of  1  gram  of  radium  would  give  off 
1,160,000  X  2500  calories,  equal  to  the  burning  of  about 
5 


(56  RADIO-ACTIVITY 

1,000,000  tons  of  coal.  It  is  rather  interesting  to  notice  the 
distribution  of  the  source  of  heat  for  the  different  radium 
elements  and  the  amount  given  off  by  the  different  forms 
of  radiation. 

Heating  effeot  of  gram  calories  per  hour, 
corresponding  to  1  grain  of  radium. 

Radium.                                a  0  y  Total. 

Emanation  ...        25 . 1  .  .  .  .  25 . 1 

Radium  A  ...        28 . 6  .  .  28 . 6 

Radium  B  .      .      .        30.5  ..  ..  30.5 

Radium  C                         39.4  4.3  6.5  50.2 


Totals      .      .      123.6  4.3  6.5  134.4 

The  radio-activity  of  the  air  is  due  principally  to  the  ema- 
nation which  arises  from  radium  in  the  earth  and  has  been 
estimated  by  different  physicists.  The  two  methods  of  col- 
lecting the  emanation  were  by  passing  air  over  cocoanut 
charcoal  and  heating  it,  then  collecting  it  in  a  suitable 
container,  or  by  passing  air  through  liquid  air,  thus  causing 
the  emanation  to  liquify  and  afterward  collecting  it  and 
estimating  by  routine  methods.  The  results  were: 

Eve  60  X  10~12  gr.  =Ra.  0.000000000060  gr.  per  cubic  meter. 

Satterly  100  X  10~12  gr.  =Ra.  0.000000000100  gr.  per  cubic  meter. 
Ashman    89  X  lO"12  gr.  =Ra.  0.000000000089  gr.  per  cubic  meter. 

The  amount  in  the  air  at  different  times  seems  to  vary 
with  atmospheric  conditions,  there  being  less  present  in 
cyclonic  weather,  when  accompanied  by  considerable  mois- 
ture; however,  before  cyclones  or  rapid  thaws  of  snow  it 
seems  to  be  the  greatest. 

While  all  these  radio-active  elements  are  constantly  under- 
going this  degeneration  it  should  be  supposed  that  in  time 
the  supply  would  become  exhausted,  but  if  it  will  be  remem- 
bered that  uranium  starts  this  group  with  a  degeneration 


RADIO-ACTIVITY  67 

period  lasting  over  eight  billion  years,  it  can  be  easily  seen 
that  the  supply  of  radium  will  at  least  be  a  factor  to  be  cal- 
culated for  many  thousands  of  years.  However,  the  fact  that 
the  degeneration  of  uranium  is  eight  billion  years  and  that 
of  radium  twenty-five  hundred  years,  gives  us  the  assurance 
that  the  yield  of  this  very  valuable  article  will  never  be 
excessive;  there  must  be  an  enormous  amount  of  uranium 
slowly  undergoing  disintegration  to  form  these  extremely 
small  portions  of  radium.  This  fact  is  observed  in  the  yield 
of  the  different  uranium  elements,  the  older  formations,  such 
as  pitchblend,  are  richer  in  radium  than  those  formed  at 
later  periods,  as,  for  instance,  the  crystals  of  uranium  found 
near  the  surface;  under  normal  conditions  the  amount  of 
each  element  is  expressed  by  the  following  table: 

Period.  Amount. 

Uranium     I    .       .  8,000,000,000  years                 1,000,000,000  mg. 

Uranium   II    .  .  2,000,000  years  250,000  mg. 

Uranium  X    .  35.5  days  0.0125  mg. 

Ionium            .  .  200,000  years  (?)  25,000  mg.  (?) 

Radium           .  .  2,500  years  312.5  mg. 

Emanation     .  .  5. 6  days  0.002mg. 

Radium  A    .  .  4.3  minutes  0.000001  mg. 

Radium  B    .  .  38. 5  minutes  0.000009  mg. 

Radium  C    .  .  28 . 1  minutes  0 . 000007  mg. 

Radium  D    .  .  24  years  3,000  mg. 

Radium   E    .  .  7.5  days  0 . 00025  mg. 

Radium   F  (Polonium)  202  days  0.071  mg. 


CHAPTER   IV. 
METHODS  OF  ESTIMATING  RADIATION. 

The  Standards  used  in  Estimating  the  Amount  of  Radiation  and  Methods 
Employed  to  Obtain  Them — The  Alpha-ray  Unit — The  Curie — Mache 
Unit — Other  Units — Methods  of  Estimation — lonization — Electroscopes  of 
Various  Forms — Fluorescent  Method — Photographic  Method. 

THE  finest  analytical  balance  could  not  weigh  the  infini- 
tesimal amount  of  a  radio-active  element  contained  within 
a  mineral  or  salt,  that  would  be  easily  detectible  by  such 
means  as  are  employed  for  the  estimation  of  these  activities. 
The  many  forms  of  apparatus  depend  upon  the  simple 
electroscope,  modified  in  some  way  to  suit  the  exigencies 
of  the  occasion.  The  ^mnnnnnr  mg.  or  soooo^oinnr  gr.  of 
radium  is  easily  demonstrated  by  an  ordinary  apparatus 
and  well-trained  technique.  Even  amounts  considerably 
more  infinitesimal  may  be  demonstrated  under  certain 
conditions. 

Until  the  International  Committee  established  the  Curie 
unit  for  the  measurement  of  radio-activity  there  were 
numerous  methods  and  standards  employed,  all  more  or 
less  confused,  depending  upon  ideas  developed  in  different 
countries  by  societies  and  individuals,  and  as  some  of 
these  standards  still  have  a  degree  of  usefulness  and  are 
quoted,  it  will  be  necessary  for  one  reviewing  the  subject  to 
have  an  understanding  of  their  usefulness  and  limitations. 
One  of  the  earliest  methods  of  estimating  the  radio-active 


METHODS  OF  ESTIMATING  RADIATION  69 

energy  of  a  salt  was  by  calculating  the  ionization  and 
comparing  it  with  a  standard  that  ranged  from  uranium 
the  base,  as  1,  to  pure  radium  bromide,  as  2,000,000. 
This  means  that  the  same  amount  of  radium  bromide 
would  ionize  2,000,000  times  faster  than  the  same  amount 
of  uranium.  The  difficulty  in  establishing  this  standard 
was  to  know  from  what  base  it  was  calculated  if  radium 
bromide  was  considered  as  RaBr2  or  as  RaBr22H2O;  or  in 
some  instances  it  was  reckoned  upon  pure  radium,  and  from 
the  stand-point  of  uranium,  the  calculations  were  as  often 
made  from  uranium  oxide,  I  aOg. 

Uranium  is  still  the  basis  for  the  standard  for  a-ray 
activity  on  account  of  the  constancy  of  this  form  of  radiation, 
as  it  is  not  affected  by  the  different  chemical  manipulations  as 
much  as  the  other  radio-active  elements,  and  it  is  conven- 
ient for  the  standardization  and  calibration  of  electroscopes, 
electrometers,  and  other  measuring  instruments  employed 
in  this  field.  For  the  preparation  of  the  disks,  a  thin  film 
of  uranium  oxide  is  prepared  by  reducing  uranium  nitrate 
with  ammonia  carbonate  in  a  platinum  crucible.  This  is 
ground  to  a  very  fine  powder  mixed  with  enough  chloroform 
to  make  a  paste,  and  then  applied  to  the  bright  and  clean 
metal  disk.  The  surface  must  be  covered  completely, 
otherwise  errors  will  result  from  uncovered  spots.  After 
the  disks  have  been  properly  prepared,  they  should  be 
allowed  to  stand  for  a  month  or  so,  being  protected  from 
dust.  Comparisons  are  then  made  by  preparing  disks  of 
the  same  size  from  the  mineral  or  salt  under  investigation. 

If  uranium,  taken  as  a  unit  standard,  is  considered  as  1, 
and  radium  bromide  as  2,000,000,  then  the  pure  radium 
element  would  have  an  activity  of  3,731,000,  the  other 
ordinary  salts  such  as  the  chloride,  sulphate,  and  carbonate 


70  METHODS  OF  ESTIMATING  RADIATION 

would  all  rate  above  the  activity  of  the  bromide,  as  the 
proportion  of  radium  to  the  salt-forming  acid  is  somewhat 
less  in  bromide.  The  method  was  usually  applied  in 
practice  to  signify  the  purity  of  a  radio-active  salt,  as  for 
instance,  if  10  mg.  of  powder  possessed  an  activity  of  100,000 
units,  it  contained  5  per  cent,  of  pure  radium,  or  radium 
bromide,  depending  upon  the  unit  used,  which  wras  purely 
arbitrary  from  the  point  of  view  of  the  examiner.  In  most 
instances  it  was  considered  as  radium  bromide,  RaB^t^O, 
and  the  activities  were  always  in  proportion  to  the  per- 
centage. 

0.5  per  cent,  of  radium  salt  would  give  an  activity  of  about  10,000 

1 . 0  per  cent,  of  radium  salt  would  give  an  activity  of  about  20,000 

5.0  per  cent,  of  radium  salt  would  give  an  activity  of  about  100,000 

50.0  per  cent,  of  radium  salt  would  give  an  activity  of  about  1,000,000 

The  basis  of  activity  would  always  give  the  amount  of 
radium,  but  the  percentages  of  salt  would  depend  upon  the 
acid  in  combination,  which,  however,  is  a  small  factor 
considering  that  the  activity  alone  depends  entirely  upon 
the  metallic  radium. 

Kilo-uranium  or  kilurane  was  suggested  by  M.  Beaudoin 
to  relieve  the  number  of  figures  in  speaking  of  the  strength 
of  powerful  radio-active  salts  in  comparison  with  uranium; 
in  other  words,  the  unit  represented  1000  uranium  units. 
The  letter  U  is  therefore  supposed  to  designate  the  standard 
of  1000,  and  therefore  500  U  would  equal  500,000  uranium 
units,  1000  U  would  equal  1,000,000  uranium  units,  etc. 
This  standard  has  not  been  generally  accepted  and  is  rarely 
used. 

Under  all  circumstances  calculation  should  be  made  upon 
the  basis  of  pure  radium  element  and  its  radio-activity  in 


METHODS  OF  ESTIMATING  RADIATION  71 

Curie  units;  the  adoption  of  this  standard  was  due  to  the 
International  Society  of  Radiology  and  Electricity,  meeting 
in  Brussels,  1910,  where  a  committee  was  appointed  to 
review  the  field  and  propound  a  proper  standard  for  the 
measurement  of  radio-activity.  This  committee  requested 
Madame  Curie  to  prepare  a  specimen  of  pure  radium  salt, 
and  from  this  make  the  deduction  as  to  the  amount  of 
activity  derived  from  it.  The  preparation  contained  22  mg. 
of  pure  radium  chloride,  and  from  it  calculations  were 
made  for  the  adoption  of  the  unit  known  as  a  "curie." 

The  Curie. — One  curie  is  that  quantity  of  radium  emana- 
tion derived  from  1  gram  of  radium  element  in  equilibrium: 
equal  to  0.6  c.mm.  at  a  temperature  of  0°  C.,  and  a  baro- 
metric pressure  of  760  mm.,  correction  for  vapor  densities, 
etc.  This  standard  is  maintained  at  Paris;  the  original 
being  maintained  alone,  away  from  all  influences  that 
in  any  way  could  affect  its  equilibrium.  From  this  one 
standard  secondary  standards  are  made  and  sent  out  to 
different  centres  such  as  Vienna,  London,  etc.,  and  from 
these  again  others  are  made  for  measurements  and  for  com- 
parisons in  ordinary  laboratory  work. 

On  account  of  the  amount  of  radium  required  to  develop 
one  curie,  it  was  thought  desirable  to  have  smaller  standards. 
This  led  to  the  adoption  of  the  millicurie. 

The  millicurie  represents  the  quantity  of  radium  emanation 
in  equilibrium  with  a  milligram  of  radium  element,  under 
the  same  normal  conditions  of  temperature  and  pressure. 

The  microcurie  is  a  still  smaller  unit  and  uses  the  micro- 
gram  or  the  millionth  part  of  1  gram  as  the  unit.  It  is 
principally  employed  in  expressing  the  amounts  of  radiation 
existing  in  earths  and  waters  that  possess  very  little 
activity. 


72  METHODS  OF  ESTIMATING  RADIATION 

The  Mache  unit  expresses  the  saturation  of  the  emanation 
of  radium,  free  from  products  of  decay,  from  1  liter  of  solu- 
tion or  gas.  It  equals  the  number  of  electrostatic  units 
multiplied  by  1000.  This  unit  is  of  value  in  expressing 
the  amount  of  radiation  in  water  or  air,  but  care  should 
be  exercised  to  mention  the  degree  of  concentration,  which 
often  is  overlooked  thereby  making  the  term  useless;  in 
other  words,  when  the  number  of  Mache  units  is  given, 
the  amount  of  gas  or  water  should  also  be  mentioned,  as, 
100  m.  u.  per  liter  in  a  bath  of  300  liters  capacity,  making 
a  total  of  300  X  100  =  30,000  m.  u. 

One  curie  of  emanation  per  liter  would  equal  a  concen- 
tration of  2,670,000,000  m.  u.  (Mache  units). 

One  Mache  unit  (10  liter  condensation  chambers)  = 
0.00632  mg.  minutes  radium  bromide;  RaBr2,  or  0.465  X 
10-9  (=  0.000000000465)  curie.  All  authorities  do  not  agree 
upon  these  figures. 

One  Mache  unit  =  75 — 150  volt  per  hour. 

1000  Mache  units  =  1  electrostatic  unit  or  2.86  X  10~7 
( =  0.000000286)  curie. 

2.15  Mache  units  =  0.0137  mg.  minutes  RaBr2  or  10~9  curie. 

The  electrostatic  unit  is  frequently  quoted  by  the  Ger- 
mans. It  represents  that  quantity  of  current  equal  to 
0.000000000333  ampere.  Thus  solutions  of  mesothorium 
and  thorium  X  for  internal  administrations  are  rated  by 
the  number  of  electrostatic  units  they  contain. 

One  curie  gives  a  saturation  current  in  an  ionization 
chamber  of  uniform  standards  of  size,  temperature,  and 
air  pressure,  of  2,670,000  electrostatic  units  =  0.89  milli- 
ampere. 

1  electrostatic  unit  =  1000  m.  u.,  or  2.86  X  10~7 
(=  0.000000286)  curie. 


METHODS  OF  ESTIMATING  RADIATION  73 

It  has  been  suggested  that  the  value  of  the  emanation 
ionization  current  be  expressed  as  the  billionth  of  an  ampere. 
This  has  not  been  generally  accepted. 

The  milligram  minute  represents  the  quantity  of  radium 
emanation  which  1  mg.  of  pure  radium  bromide  (anhydrous) 
produces  in  one  minute,  and  equals  0.73  microcurie,  or 
about  180  Mache  units  per  liter. 

1  milligram  minute  of  emanation  of  radium  element  = 
125.0  X  10-9  curie. 

1  milligram  minute  of  emanation  of  radium  bromide, 
RaBr2  =  157.9  Mache  units,  or  73.4  X  10'9  ( =  0.0000000734) 
curie.  (This  is  disputed  by  some  authorities  as  not  exact.) 

The  milligram  second  represents  the  quantity  of  radium 
emanation  produced  in  1  second  by  1  mg.  of  radium  bromide 
in  the  anhydrous  state,  and  equals  about  0.00122  microcurie, 
or  about  2.4  Mache  units. 

1  milligram  second  emanation  of  radium  element  = 
2.08  X  10-9  ( =  0.00000000208)  curie. 

1  milligram  second  emanation  of  radium  bromide  (RaBr2) 
=  1.22  X  10-9  (=  0.00000000122)  curie. 

1  milligram  second  emanation  of  radium  bromide  (RaBr2  + 
2H20)  -  2.4  Mache  units  or  1.116  X  lO'6  (  =  0.000001116) 
curie. 

These  last  two  units  have  been  employed  to  express  the 
amount  of  radiation  from  natural  sources,  such  as  springs. 

1  gram  second  emanation  of  radium  element  =  2.08  X 
lO-e  ( =  0.00000208)  curie. 

1  gram  second  emanation  of  radium  bromide,  RaBr2  = 
3.54  X  10-6  ( =  0.00000354)  curie. 

Milligram  hour  is  a  term  suggested  by  Turner,  of  Edin- 
burgh, and  is  likely  to  be  confused  with  the  milligram 
minute  and  milligram  second.  However,  its  purpose  is 


74  METHODS  OF  ESTIMATING  RADIATION 

entirely  different.  He  suggested  it  in  order  to  give  the 
amount  of  radiation  in  the  same  manner  as  that  employed 
in  denoting  the  flow  of  electricity,  as  the  ampere  hour;  for 
example,  a  10-milligram  specimen  of  pure  radium,  applied 
for  one  hour,  would  be  called  10  milligram  hours,  and  cor- 
rections made  according  to  the  time  and  strength  of  the 
radium.  If,  for  instance,  a  1,000,000  unit,  5-milligram  salt 
of  radium  be  applied  for  one  hour,  the  total  would  be  2| 
milligram  hours.  The  unit  is  employed  in  therapeutics. 

Volts  per  hour  is  a  method  of  expressing  the  amount  of 
emanation  from  a  liter  of  solution  or  gas  as  observed  from 
the  movement  of  the  electroscope.  The  scales  of  some 
instruments  are  so  calibrated  as  to  correspond  to  the  inpo- 
jtentials  and  read  as  volts. 

Volts  per  minute  is  employed  in  exactly  the  same  manner, 
but  does  not  give  such  enormous  figures  as  the  preceding. 

Both  these  terms  are  confusing  and,  like  many  of  the 
others,  should  be  abandoned. 

Uranium  unit  expresses  the  amount  of  ionization  from 
the  radiation  of  uranium  oxide,  Ur2O5,  chemically  pure 
and  properly  aged,  spread  upon  a  plate  6  cm.  in  diameter, 
in  an  ionizing  chamber  of  definite  dimensions.  Calculations 
are  made  upon  the  basis  of  metallic  uranium.  It  equals 
about  22.02  X  10'6  millicuries. 

At  the  present  time  there  is  no  direct  method  of  com- 
paring, from  a  medical  standpoint,  the  amount  of  radiation 
from  these  radio-active  salts,  with  that  developed  by 
artificial  means,  as  for  instance,  Roentgen  rays.  Such  units 
as  Holzknecht,  Sabouraud,  Keinboch  and  others  used  in 
obtaining  the  amounts  of  x-ray,  fail  to  give  the  correct 
interpretation  of  the  radiation  from  these  natural  products. 
However,  the  means  used  in  estimating  the  .amount  of 


METHODS  OF  ESTIMATING  RADIATION  75 

radiation  give  far  more  uniform  standards  than  those 
adopted  for  the  measurement  of  the  Roentgen  rays. 

When  the  radiation  from  a  certain  amount  of  radium  has 
been  once  ascertained,  it  continues  to  give  off  the  same 
proportion  of  a-,  /3-,  and  7-rays  continuously,  without  varia- 
tion, for  a  definite  period.  The  different  metal  screens  inter- 
posed may  cut  off  a  given  amount  of  ray,  but  it  too  can 
be  measured,  and  it  will  cut  off  the  same  amount  of  radia- 
tion under  similar  conditions  when  or  where  applied.  It  is 
constant,  and  therefore,  under  all  circumstances,  the  amount 
of  radiation  can  be  estimated  for  any  degree  of  penetration. 
It  is  possible  to  measure  the  amount  and  penetration  of  the 
Roentgen  rays,  but  they  are  by  no  means  constant  and 
vary  between  limits  under  the  most  skilled  manipulation, 
and  while  it  is  possible  to  obtain  an  approximate  idea  of  the 
total  amount  of  radiation,  both  in  quantity  and  quality,  an 
exact  idea  is  impossible,  and  all  the  methods  devised  for 
reading  the  quantity  of  .r-ray  are  subject  to  some  variation. 

Methods  of  Estimation. — There  are  three  ways  of  estimating 
the  amount  of  radiation  from  these  radio-active  elements. 
They  are: 

1.  The  ionization  method,  which  is  the  most  accurate,  and 
is  employed  where  exact  measurements  are  desired. 

2.  By  the  effects  of  these  radio-active  salts  upon  the 
photographic  plate.    This  method  is  rather  tedious,  but  the 
results  are  permanent  and  can  be  used  for  comparison. 

3.  By  the  brilliance  of  different  fluorescent  substances 
produced  from  the  radiation  of  these  elements.     This,  like 
the  second  method,  is  subject  to  personal  equation,  much 
depending  upon  the  operator's  judgment.     The  first  gives 
accurate  results,  while  the  other  two  are  extremely  crude  and 
only  give  a  relative  idea  of  the  actual  amount  of  activity. 


76 


METHODS  OF  ESTIMATING  RADIATION 


Electroscope. — The  measurement  of  all  the  radio-active 
salts  depends  upon  the  electroscope,  and  on  account  of  its 
extreme  sensitiveness,  the  amount  of  radio-active  elements 
must  be  extremely  small  not  to  be  detectable,  and  while 
these  electroscopes  are  open  to  many  sources  of  error,  if 
they  are  handled  with  any  degree  of  care,  under  skilled 
manipulation  these  errors  are  not  likely  to  occur. 

FIG.  17 


Electroscope  charged  by  rod  c;  it  is  never  necessary  to  touch  plate  b, 
as  it  would  likely  tear  the  thin  gold  leaf  a,  a. 


The  general  principle  upon  which  these  electroscopes 
measure  the  quantity  of  radiation  is  from  the  ionization 
of  the  air  by  these  radio-active  elements,  thus  causing  the 
discharge  of  the  charge  held  within  the  insulated  portion  of 
the  apparatus.  The  stronger  the  activity,  the  more  rapidly 
the  gas  about  the  electroscope  is  ionized;  the  greater  the 
ionization,  the  sooner  the  charge  is  dispersed. 


METHODS  OF  ESTIMATING  RADIATION 


i  i 


RELATIVE  IONIZATION  PRODUCED  IN  VARIOUS  GASES  BY  a- 

COMPARED  WITH  AlR. 


Gas. 

Density. 

a 

ft 

7 

X 

Air 

1. 

1. 

1. 

1. 

1. 

H 

.069 

.24 

.115 

.16 

0.114 

0 

1.11 

1.15 

1.17 

1.16 

1.39 

N2O 

1.53 

1.53 

1.55 

1.55 

CO2 

1.53 

1.59 

1.6 

1.58 

1.6 

The  ordinary  electroscope  of  the  laboratory  consists  of 
two  thin  strips  of  gold-foil,  suspended  by  a  brass  rod  within 
a  glass  globe  properly  insulated,  and  extends  outside  so  as  to 


FIG.  18 


Diagrammatic  sketch  of  an  electroscope  made  of  lead  3  mm.  thick:  B, 
the  ionizing  chamber;  A,  the  electroscope  proper;  g,  the  gold  leaf  attached 
to  the  metal  rod  c,  which  is  connected  with  plate/,  which  is  exactly  opposite 
and  the  same  size  as  the  ionizing  plate  e,  upon  which  the  material  to  be 
tested  is  placed;  d  is  an  insulating  button  of  sulphur  or  amber. 

receive  the  charge.  The  charging  is  usually  accomplished 
by  rubbing  a  rod  of  hard  rubber,  sulphur,  or  amber  with  a 
piece  of  wool  or  silk  and  bringing  it  into  close  proximity  with 


78 


METHODS  OF  ESTIMATING  RADIATION 


the  rod  upon  which  the  gold  leaf  is  suspended.  The  charge 
must  not  be  too  great  or  it  will  cause  the  two  sheets  of 
gold-leaf  to  separate  too  rapidly,  which  is  very  apt  to  tear 
them. 

FIG.   19 


An  electroscope  used  at  the  Oncologic  Hospital:    C,  the  ionizing  chamber; 
B,  electroscope  proper;  A,  cap  covering  the  insulated  rod  holding  the  leaf. 

For  the  calculation  of  radio-activity  electroscopes  must 
be  made  of  lead  boxes  to  cut  off  all  radiation  except  that 
portion  under  observation.  The  lead  from  which  they  are 
built  should  be  preferably  old  lead  that  has  had  sufficient 
time  to  allow  the  radio-lead,  which  is  always  present  in  new 
lead,  to  disappear.  While  radio-lead  is  not  especially  active, 
its  products  of  disintegration  are,  and  they  deliver  a  radia- 
tion that  will  cause  some  trouble  in  accurate  calculations. 


METHODS  OF  ESTIMATING  RADIATION 


79 


It  must  also  be  remembered  that  where  these  instruments 
are  to  be  used  the  radio-active  elements  should  never  be 
exposed.  They  must  always  be  enclosed  in  some  form  of 
container,  otherwise  the  emanation  escapes,  diffuses  through 
the  air  of  the  room,  and  coats  everything  with  an  invisible  film 


FIG.  20 


Same  electroscope  taken  apart  to  show  construction:  B,  a  plate  upon 
which  the  substance  to  be  studied  is  placed.  The  leaf  at  E  is  held  out 
by  the  charge  of  the  hard  rubber  rod. 


of  the  product  of  decay,  causing  it  to  become  radio-active, 
and  ruins  that  building  and  everything  in  it  for  future 
experiments  which  depend  upon  delicate  electric  dis- 
charges. 

With  the  ordinary  electroscope  a  fair  idea  of  the  amount 
of  radiation  can  be  easily  studied.      For  the  calculation  of 


80  METHODS  OF  ESTIMATING  RADIATION 

the  alpha-radiation  the  flat  disk  in  the  ionizing  chamber  of 
the  electroscope,  opposite  the  disk  attached  to  the  electro- 
scope proper,  is  covered  with  a  thin  layer  of  the  material  to 
be  studied,  and  although  the  ft-  and  7-radiation  are  included 
under  these  circumstances,  the  a-radiation  so  greatly  pre- 
dominates that  they  need  not  ordinarily  be  taken  into 
consideration.  Where  the  radio-activity  is  extremely  small, 
calculations  are  always  made  upon  the  basis  of  the  a-rays. 
If,  however,  the  /3-rays  are  to  be  estimated,  a  covering 
sufficient  to  cut  off  all  a-rays  is  placed  over  the  disk  of 
radio-active  elements.  Finally,  for  the  study  of  the  7-rays, 
a  thick  layer  of  lead  is  placed  over  the  disk,  in  this  way 
eliminating  the  a-  and  /3-rays.  While  this  method  gives  an 
approximate  idea  of  the  different  rays,  it  is  by  no  means 
exact,  and  where  it  is  desired  to  obtain  an  accurate  measure- 
ment of  each  of  the  rays,  it  must  be  substituted  by  a 
complicated  electrical  method  for  their  separation. 

Specimens  of  radio-active  salts  containing  a  fair  percentage 
of  activity  are  always  studied  by  the  amount  of  7-radiation 
in  comparison  with  a  specimen  of  known  standard.  The 
process  is  as  follows:  The  electroscope  is  charged,  and 
note  made  that  it  retains  its  charge.  The  specimen  of 
known  standard,  covered  by  a  piece  of  lead  3  mm.  thick, 
is  placed  at  a  certain  distance  from  the  electroscope.  The 
drop  in  the  gold-leaf  (known  technically  as  the  leak)  is 
carefully  observed,  during  a  given  cycle  of  time,  usually 
one  minute,  and  taken  by  a  stop-watch;  this  reading  is  made 
several  times  for  accuracy  and  to  avoid  mistakes.  For 
instance,  the  microscopic  scale  shows  that  at  the  first 
reading,  it  dropped  14.5  points;  at  the  second,  15.5  points; 
and  at  the  third,  15;  proving  that  the  conditions  were 
nearly  equal,  with  no  great  variation,  and  would  give  a 


METHODS  OF  ESTIMATING  RADIATION 


81 


common  factor  of  15.  The  specimen  to  be  examined  is 
now  substituted  for  the  known  standard,  and  readings  are 
made  from  it,  in  the  same  manner;  and  the  common  factor 
found  to  be  20;  the  standard  contained  10  mg.  of  radium 


FIG.   21 


Electroscope  for  testing  /3-  and  y-radiation. 

salt  of  30  per  cent,  radium  element.  The  salt  on  trial  weighs 
20  mg.  The  percentage  of  radium  is  found  by  the  follow- 
ing calculation: 

Standard          leak  15  weight  10  percentage  30  per  cent. 

Specimen          leak  20  weight  20  percentage  ? 

10       15  10     20     30 

x  =  —  -5-  —  X  30  or  x=  —  X  —  X  —  =20  per  cent. 

20       20  20      15       1 

6 


82  METHODS  OF  ESTIMATING  RADIATION 

Any  movement  near  these  sensitive  instruments  is  likely 
to  cause  some  influence  upon  the  result;  therefore  absolute 
quietness  must  be  maintained  while  readings  are  being  made 
from  the  electroscope. 

Under  some  circumstances  the  weight  of  the  mass  cannot 
be  definitely  ascertained,  as  for  instance,  where  the  emana- 
tion is  employed  for  treatment.  Then  the  amount  of  radia- 
tion can  only  be  compared  with  the  standard  and  spoken  of  as 
an  amount  of  radiation  equal  to  a  certain  quantity  of  radium 
element.  The  estimation  of  thorium  preparations  are  made 
in  like  manner,  the  radio-activity  is  based  entirely  upon 
"radium  element"  and  not  upon  the  percentage  of  thorium 
element,  and  as  these  thorium  preparations  are  more  active 
than  the  preparations  of  radium,  it  is  not  unusual  to  go  above 
the  100  per  cent,  mark  in  these  readings. 

Liquids  and  gases  demand  a  somewhat  different  form  of 
electroscope.  The  ionizing  chamber  is  made  so  it  can  be 
sealed,  and  the  emanation  is  carried  into  it  as  a  gas  (if  a 
liquid  it  is  slowly  boiled);  through  it  a  current  of  air  is 
passed,  rather  slowly.  This  is  accumulated  in  the  ionizing 
chamber  and  measured  in  the  same  manner  as  before. 

There  are,  however,  several  special  forms  of  electroscopes 
upon  the  market  that  are  calibrated  to  read  in  electrostatic 
units  or  Mache  units,  and  have  been  given  the  technical 
name  of  Fontactoscopes.  Some  are  so  arranged  that  the 
water  is  introduced  into  the  ionizing  chamber  before  the  air 
is  passed  through,  thus  preventing  escape  of  the  emanation 
in  the  transfer.  (See  Fig.  46,  p.  170.) 

Another  form  of  measuring  apparatus  employed  for  the 
study  of  these  radio-active  elements  is  the  electrometer, 
and  while  there  are  as  many  modifications  of  these  in- 
struments as  of  electroscopes  proper,  the  general  principle 


METHODS  OF  ESTIMATING  RADIATION  83 

is  practically  the  same,  and  depends  upon  some  form  of 
charging  device  that  delivers  to  the  electrometer  a  variable 
current,  capable  of  being  increased  or  diminished  according 
to  the  ionization  of  the  air  in  the  ionizing  chamber.  From 
the  saturation  of  the  apparatus  the  amount  of  radiation 
from  the  article  under  examination  is  estimated. 

There  are  several  methods  of  showing  the  value  of  radium 
which  can  be  easily  carried  out  by  those  not  experienced  in 
the  use  of  such  a  delicate  physical  apparatus.  While  these 
methods  are  not  dependable  for  estimating  the  actual 
amount  contained,  they  may  be  of  use  in  showing  the 
relative  value  of  the  radio-active  specimens  under  examina- 
tion by  the  actual  strength  of  radiation  contrasted  with 
another  known  specimen. 

Fluorescent  Method. — The  simplest  of  all  methods  is  the 
comparison  of  the  amount  of  fluorescence  produced  by  the 
action  of  the  radio-active  salt  upon  certain  chemicals,  such  as 
platinum  barium  cyanide  or  willemite,  and  from  the  effect 
upon  the  specimens  examined  to  determine  which  causes 
it  to  glow  the  brightest.  By  removing  the  radium  about  4 
inches  or  10  cm.  practically  all  the  a-radiation  is  lost  and  at 
this  point  the  /3-radiation  can  then  be  calculated.  By  remov- 
ing it  still  further,  usually  about  2  feet  or  \  meter,  and 
covering  the  salt  with  a  thin  sheet  of  lead,  the  a-  and  /3- 
radiation  is  obstructed  and  the  7-radiation  alone  may  be 
estimated.  For  the  a- ray  it  is  best  to  use  a  small  screen  of 
zinc  sulphide. 

Photographic  Method. — A  method  that  is  somewhat  more 
troublesome  is  one  that  depends  upon  the  photographic 
effect  of  these  salts,  upon  the  ordinary  silver  dry  plate. 
Dr.  Robert  Abbe,  of  New  York,  was  the  first  to  call  atten- 
tion to  this  method,  and  it  has  since  been  known  by  his 


84  METHODS  OF  ESTIMATING  RADIATION 

name.  It  consists  in  making  graded  consecutive  exposures 
upon  one  plate  for  the  same  or  different  specimens  of  radio- 
active salts;  for  instance,  a  small  window  is  cut  in  a  piece 
of  sheet  lead;  above  this  window,  at  a  given  height,  pos- 
sibly 1  or  2  inches,  is  placed  the  specimen  to  be  examined. 
It  is  then  allowed  to  remain  over  one  spot  for  five  seconds; 
next  for  ten,  fifteen,  twenty,  and  so  on  up  to  sixty  seconds; 
then  on  a  line  below,  the  next  specimen  to  be  examined  is 

FIG.  22 


Abbe's  method  of  testing  the  amount  of  activity.  Dry  plate  wrapped 
in  paper;  over  this  a  plate  of  lead  with  a  small  window;  above  the  window 
the  cell  containing  the  element  to  be  tested. 


run  through  the  same  cycles.  The  photographic  plate  is 
placed  in  the  ordinary  black  paper  in  the  same  way  as 
when  an  x-ray  exposure  is  to  be  made;  in  other  words,  it  is 
protected  from  daylight.  After  the  exposure  has  been 
completed,  and  developed  under  usual  conditions,  there  will 
be  found  upon  this  plate  a  gradation  of  shadows  depending 
entirely  upon  the  length  of  time  of  exposure  and  the  strength 
of  the  radio-active  salt.  The  longest  and  strongest  produce 


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METHODS  OF  ESTIMATING  RADIATION  85 

the  deepest  shade,  and,  conversely,  the  weakest  and  shortest 
the  palest. 

By  this  method  it  is  also  possible  to  show  the  effect  of 
filters  and  the  amount  of  secondary  radiation  which  is  set 
up  by  them.  Certain  metals  have  a  very  strong  secondary 
radiation,  and  it  is  often  possible  to  demonstrate  this  by  a 
strong  precipitation  of  the  silver  upon  the  photographic 
plate.  Lead  and  aluminium,  two  metals  most  used  as  filters, 
seem  to  be  leaders  in  this  class. 

These  crude  methods  are  extremely  interesting,  but  it 
should  be  remembered  that  their  variation  and  the  personal 
equation  are  such  factors  that  for  any  serious  consideration 
they  must  be  set  aside.  At  the  same  time,  where  measure- 
ments are  to  be  made  for  standards,  they  must  be  made  by 
the  most  careful  physicists,  and  should  always  be  subjected 
to  several  crucial  tests  before  they  are  accepted. 


CHAPTER  V. 
RADIUM. 

Methods  of  Employing  Radium — Local — Direct  Application — Bandages 
— Clothing — Protected  in  an  Applicator — Direct  Application  of  the  Emana- 
tion— Water — Charcoal — Protected  Applicators — Apparatus  Used  to  Col- 
lect the  Emanation — Use  of  Radium  in  Internal  Medicine — Use  of  the 
Emanation — Baths — Injection — Hypodermically  —  Intravenous  — Absorp- 
tion During  Inspiration. 

Methods  of  Employing  Radium. — The  use  of  radium  as  a 
therapeutic  agent  must  be  considered  from  two  standpoints, 
(1)  as  a  local  application  and  (2)  as  a  general  medicine,  and 
under  these  two  headings  others  must  be  made  on  account 
of  the  peculiar  nature  of  the  radio-active  elements.  These 
methods  differ  to  some  extent  with  reference  to  each 
element,  depending  upon  the  period  of  life  of  their  disin- 
tegration products,  and  at  times  considerable  modification 
of  the  routine  must  be  adopted  to  circumvent  the  loss  of 
some  valuable  cycles  in  the  period  where  for  some  reason 
it  is  most  desirable  that  they  should  be  retained. 

Radium  gives  an  extremely  wide  range  of  usefulness, 
as  its  emanation  has  a  very  active  period  of  about  four 
days,  and  therefore  gives  sufficient  time  to  incorporate  it  in 
some  material  where  it  has  a  distinct  action.  For  this 
reason  it  has  taken  a  place  as  the  type  of  the  different 
elements  of  its  class,  and  has  gained  popularity. 

For  the  therapeutic  study  of  radium  it  will  be  divided  into 
the  following  divisions: 


METHODS  OF  EMPLOYING  RADIUM  87 

A.  Locally: 

1.  By  direct  application  of  the  salt: 
(a)  Naked  or  exposed  salt. 

(6)  Protected,  or  in  a  capsule  of  some  material,  glass, 
aluminium,  platinum,  etc. 

2.  By  direct  application  of  the  emanation: 

(a)  By    applying    the    emanation    incorporated    in 

solution  of  water  or  other  liquids. 
(6)  By  applying  the  emanation  contained  in  some 

inert  powder,  such  as  charcoal,  or  made  into 

ointment  pastes,  etc. 
(c)  By  applying  the  emanation  contained  in  a  small 

tube  of  glass  or  metal. 

B.  As  a  general  medicine  it  may  be  employed: 

1.  As  radium  salts. 

2.  As  the  emanation. 
Which  may  be  administered: 

A.  In  solutions,  or  incorporated  with  some  inert  material, 
and  given   internally    by  mouth,  rectum,  or  any  of   the 
natural  passages,  used  in  the  administration  of  medicine 
under  ordinary  circumstances. 

B.  Injection,   in  solution  and  properly  prepared  to  be 
given  hypodermically  under  the  usual  conditions,  or,  where 
the  occasion  demands,  may  be  used  intravenously. 

C.  By  the  inspiration  of  radio-active  air.     This  method 
might  be  said  to  be  unique,  but  is  similar  to  those  where 
ozone  has  previously  been  employed. 

Radium  in  the  naked  state  is  rarely  used  except  in  a  low- 
grade  salt.  The  liability  of  losing  a  small  particle  of  a  high- 
grade  salt  in  an  unprotected  state,  makes  this  form  of 
treatment  practically  prohibitory.  There  is  also  another 
reason  of  greater  importance  which  debars  its  use;  that  is, 


88  RADIUM 

if  a  small  particle  of  one  of  these  high  grade  salts  becomes 
imbedded  in  the  skin  of  the  individual  handling  it,  the 
consequent  burn  will  naturally  be  serious;  for  it  is  impos- 
sible to  remove  the  extremely  small  traces  of  radium  when 
it  once  becomes  attached  to  any  article. 

For  the  treatment  of  some  chronic  diseases  of  the  skin, 
with  a  wide-spread  distribution,  articles  of  underwear  have 
been  treated  with  a  low-grade  radium  salt,  thus  making 
them  weakly  radio-active.  Bandages  and  pads  of  various 
sizes  and  shapes  are  also  impregnated  with  these  salts; 
under  some  circumstances  they  are  dissolved  in  a  very 
weak  varnish  which  fixes  them  to  the  material;  while 
others  have  recommended  that  the  garment  be  immersed 
in  a  solution  of  the  salts  and  allowed  to  dry.  Where  the 
varnish  is  used,  the  radio-activity  of  the  alpha-ray  is  some- 
what diminished,  and  as  these  articles  practically  derive 
their  therapeutic  value  from  this  form  of  radiation,  this 
point  must  be  considered. 

Toiles  prepared  from  radium  salts  are  in  practically  the 
same  class,  except  that  they  are  made  from  a  stronger 
radium  preparation  and  are  standardized  according  to  their 
size,,  having  enough  radium  embedded  in  them  to  make 
them  of  decided  value;  where  they  contain  a  considerable 
amount  of  radio-active  salt,  great  care  must  be  taken  with 
them,  as  in  time  they  become  extremely  brittle,  due  to  the 
action  of  the  radiation  upon  the  fabric.  The  material  used 
is  usually  silk  or  wool,  and  the  radium  salt  is  often  applied 
in  the  form  of  a  varnish,  which  insures  protection  to  the 
salt  and  also  to  the  patient;  and  their  strength  is  usually 
rated  by  the  amount  of  radium  salt  per  square  inch,  or,  as 
their  use  has  been  more  or  less  confined  to  the  European 
Continent,  the  rating  is  usually  by  the  square  centimeter. 


METHODS  OF  EMPLOYING  RADIUM  89 

Their  employment  has  been  found  useful  in  certain  condi- 
tions of  the  skin,  such  as  chronic  eczema,  psoriasis;  or 
where  the  disease  is  widely  disseminated. 

Applicators. — The  most  common  method  of  application 
of  radium  is  in  one  of  the  different  forms  of  containers 
or  radiodes,  concave  disks  of  horn,  hard  rubber  or  metal, 
covered  with  mica,  or  a  small  glass  bottle  or  sealed  tube, 
and  numerous  other  designs,  suited  to  the  fancy  of  the 
operator.  The  only  rule  to  be  observed  is,  where  low  rays 
are  to  be  desired,  the  thinner  the  wall  of  the  container 
the  greater  the  radiation,  and  where  these  low  rays  are 
not  desired  the  thickness  of  the  container  is  not  to  be  con- 
sidered. 

The  manner  in  which  the  radium  is  placed  in  these  appli- 
cators should  be  observed,  as  it  greatly  affects  the  position 
of  the  salt  when  in  use;  if  the  tube  is  a  large  one  and  the 
amount  of  radium  small,  the  bulk  of  the  salt  will  naturally 
fall  to  the  bottom;  however,  if  the  tube  is  placed  upon  its 
side,  and  covered  with  some  article  that  is  not  transparent, 
it  is  quite  probable  that  the  activity  of  the  tube  will  be  in 
the  place  where  least  desired.  Therefore,  these  tubes  should 
be  just  large  enough  to  contain  the  salt,  without  allowing 
it  space  enough  to  become  scattered,  yet  leaving  sufficient 
room  for  the  gas  formation  within  the  tube;  otherwise  they 
are  likely  to  explode  and  usually  this  accident  takes  place 
while  the  tube  is  being  handled.  This  phenomenon  may  be 
compared  to  many  other  physical  crises  which  take  place 
at  the  moment  of  agitation. 

The  four  salts  of  radium,  usually  employed  in  making 
these  applicators,  are  the  sulphate,  carbonate,  chloride, 
and  bromide;  they  are  rarely  found  pure  in  the  open 
market,  and  their  purity,  as  a  rule,  is  not  of  vital  import- 


90  RADIUM 

ance;  the  by-products  found  with  them  are  not  at  all 
harmful,  nor  do  they  in  any  way  interfere  with  the  radiation, 
the  principal  factor  is  the  amount  of  "radium  element," 
they  contain.  There  has  been  considerable  argument  over 
this  subject,  many  contending  that  pure  salts  must  be 
obtained  for  use,  and  yet,  these  same  pure  salts  are  covered 
with  many  thicknesses  of  lead  which  obstruct  the  radiation 
to  the  same  degree.  The  advantage  in  obtaining  a  salt 
of  high  percentage  is  that  it  occupies  a  very  small  space 
and  can  be  handled  to  advantage  where  it  is  desired  for  use 
in  cavities,  as  for  instance  50  mg.  of  a  50  per  cent,  radium 
salt  would  occupy  a  small  tube  2  mm.  wide  by  15  mm.  long, 
or  yJg-  inch  by  f  inch,  while  the  same  specimen  of  5  per  cent, 
would  require  a  tube  about  three  times  as  wide  and  nearly 
twice  as  long.  The  solubility  of  these  salts  makes  very  little 
difference  in  the  preparation  of  the  applications;  except, 
where  a  fine  division  upon  a  surface  is  required,  as  in  making 
"toiles"  or  in  varnish  applications.  If  a  perfectly  even  surface 
is  desired,  it  is  better  to  use  a  soluble  salt  such  as  the  chloride 
or  bromide;  the  evenness  of  these  surfaces  cannot  be  obtained 
by  the  use  of  the  insoluble  salt  such  as  the  sulphate  or  car- 
bonate, which,  if  applied,  must  be  in  the  form  of  an  emulsion. 
Where  the  radium  is  placed  upon  an  applicator  not  protected 
by  a  varnish,  it  is  better  to  employ  the  insoluble  salts;  for 
the  soluble  salts  are  slightly  deliquescent  and  therefore 
take  up  the  moisture  of  the  air,  and,  if  splashed  with  water 
suffer  considerable  injury. 

The  uniform  activity  of  radium  makes  it  especially  desir- 
able, and  for  this  reason  it  is  to  be  preferred,  to  the  salts  of 
other  radio-active  elements.  When  radium  gains  its  equi- 
librium, which  is  in  about  one  month  after  its  preparation, 
it  continues  to  give  off  a-,  /3-,  and  7-rays  in  the  same 


METHODS  OF  EMPLOYING  RADIUM  91 

proportion  with  but  very  little  variation  for  twenty-five 
hundred  years;  therefore  when  a  given  specimen  has  been 
measured,  and  the  actual  amount  of  a-,  /3-,  and  7-radiation 
determined;  further  estimations,  at  stated  intervals,  are 
only  required  to  determine  loss  by  accident,  otherwise 
they  would  be  unnecessary  and  of  very  little  practical 
value.  Aside  from  these  physical  properties  of  the  radium 
salts  the  only  consideration  is  the  amount  of  "radium 
element"  contained  within  a  given  applicator,  its  size,  and 
the  proportion  of  the  different  forms  of  a-,  /3-,  and  7-radia- 
tion  occasioned  by  the  different  substances  used  to  protect 
or  enclose  it. 

The  emanation  of  radium  may  be  employed  under  exactly 
the  same  condition  as  the  various  salts;  it  has,  however, 
a  wider  application,  and  while  its  preparation  requires 
some  skill,  it  possesses  many  advantages,  with  but  few 
disadvantages.  The  life  of  the  emanation  is  very  short,  as 
one-half  the  element  is  lost  in  four  days,  and  all  in  about  one 
month;  therefore,  where  it  is  to  be  employed  constantly,  fresh 
preparations  must  be  frequently  made,  and  for  this  purpose 
a  large  supply  of  radium  is  necessary.  However,  if  a  tube 
containing  the  emanation  is  injured  or  lost,  its  value  is  not 
great  compared  with  the  amount  of  radium  required  to 
supply  the  same  activity.  The  supply  can  always  be  secured 
in  the  place  most  advantageous  for  its  preservation  and  the 
emanation  used  as  a  therapeutic  agent  at  any  point  within 
a  day's  travel.  The  emanation  is  more  commonly  used  than 
the  radium  salts  in  making  direct  local  applications  over 
large  areas  and  is  usually  employed  in  the  form  of  a 
bath,  charged  according  to  the  strength  desired;  but  as 
its  use  is  in  conjunction  with  the  internal  administration,  it 
will  be  considered  under  that  section.  For  local  application, 


92 


RADIUM 


the  emanation  may  be  applied  as  an  ointment,  paste  or 
powder;  and  for  this  purpose  its  preparation  may  be  made 
by  a  method,  recommended  by  the  late  Dr.  Shober, 
which  depends  upon  the  absorption  of  the  emanation  by 
cocoanut  gharcoal.  The  radium  is  dissolved  in  water 
which  has  been  slightly  acidulated  with  hydrochloric  acid. 
Through  this  solution  a  stream  of  air  is  slowly  passed 

FIG.  23 


Apparatus  designed  by  Dr.  Shober  for  charging  charcoal  with  the 
emanation. 


which  carries  with  it  the  emanation;  this  mixture  is  then 
passed  through  a  vessel  containing  freshly  prepared  cocoanut 
charcoal,  which,  on  account  of  its  affinity  for  the  emanation, 
retains  it  and  allows  the  air  to  escape.  This  method  is 
extremely  simple  in  detail  and,  where  a  low-grade  activity 
is  desired,  fulfils  the  purpose  admirably.  It  is  not  to  be 
employed  where  concentrated  activities  of  high  values  are 
desired. 


METHODS  OF  EMPLOYING  RADIUM  93 

The  emanation  of  radium  for  use  in  the  treatment  of 
tumors  and  deep-seated  diseased  conditions  must  be  pre- 
pared with  care,  and  due  consideration  for  the  amount 
of  activity  is  desired.  While  a  number  of  different  forms 
of  apparatus  have  been  used  for  this  purpose,  the 
principles  are  essentially  the  same  and  consist  of  three 
separate  parts:  (1)  the  apparatus  containing  the  radium, 
and  collecting  the  emanation;  (2)  an  apparatus  for  removing 
the  gases;  and  (3)  a  pump  to  place  the  emanation  in  the 
desired  apparatus  for  use  in  treatment. 

The  collecting  apparatus  consists  of  a  flask  or  series  of 
flasks  containing  radium  in  solution  that  is  slightly  acidu- 
lated with  hydrochloric  acid.  This  flask  is  attached  to  a 
pump  for  removing  the  air  and  subsequently  to  remove 
the  emanation  and  gases  formed  by  the  action  of  disinte- 
gration of  radium  in  water.  The  pump  is  a  mercury  tube 
about  a  meter  long  and  acts  also  as  a  seal  when  not  in  use, 
keeping  the  flasks  containing  the  solutions  air  tight.  When 
sufficient  emanation  has  collected,  it  is  pumped  off  with 
the  gases,  Irvdrogen  and  oxygen  (which  form  coincidently 
with  it),  and  is  transferred  by  a  small  tube  over  mercury 
to  a  gasometer,  where,  by  decreasing  the  pressure  and 
lowering  the  column  of  mercury,  the  density  is  lowered  so 
it  can  be  exploded  without  danger  of  bursting  the  appara- 
tus. This  is  accomplished  by  having  two  electrodes  inside 
the  gasometer  and  passing  an  electric  spark  through  the 
mixture.  There  still  remains  some  residual  gas  and,  while 
the  quantity  is  not  great,  it  may  be  removed  by  placing 
the  container  in  a  vessel  holding  liquid  air:  this  causes  the 
emanation  to  condense  upon  the  sides  and,  while  in  this 
cold  state,  the  residual  gases  may  be  removed  by  the  third 
piece  of  apparatus  which  is  an  ordinary  mercury  pump. 


94 


RADIUM 


FIG.  24 


FIG.  25 


Diagram  of  apparatus  for  removal  of  the  emanation. 

Radium  is  dissolved  in  flasks  a  a.  The  solution  is  slightly  acidulated ;  all 
the  air  is  driven  out  of  bulb  x  through  c  by  raising  e  filled  with  mercury. 
Upon  lowering  e  a  vacuum  is  produced  in  x,  the  tube  at  the  lower  end 
being  longer  than  760  mm.  height  of  mercury  under  ordinary  atmospheric 
conditions.  The  stop-cock  s  is  now  turned  so  as  to  open  a  a  into  x,  when 
all  the  gases  contained  enter  b  in  the  proportion  to  their  volume.  Tube 
d  filled  with  mercury  is  now  placed  over  the  outlet  at  m,  the  mercury  being 
high  enough  to  cover  outlet,  The  stop-cock  s  is  turned  so  the  gas  in  b  can 
be  forced  out  into  the  tube  d;  this  is  repeated  several  times  until  the  gas 
in  the  flasks  a  a  has  been  transferred  to  d.  Tube  d  is  then  removed  to  the 
gasometer  (Fig.  25),  mercury  bath  m,  and  placed  over  the  inlet  tube,  care 
being  taken  not  to  allow  any  air  to  enter  tube  d  in  the  transfer.  By  lower 
mercury  holder  e  all  the  gas  is  drawn  into  the  tube  6,  having  first 
removed  the  air  by  adjusting  stop-cock  s.  After  the  gas  has  entered  tube 
b  it  can  be  measured,  and  then  by  lowering  e  it  is  rarefied  to  a  high 
degree ;  an  electric  discharge  is  then  sent  through  the  terminals  c  c,  which 


METHODS  OF  EMPLOYING  RADIUM  95 

FIG.  26 


Diagram  of  apparatus  for  separating  excess  of  gases  from  the  emanation. 


causes  the  gases  to  explode.  Then  if  the  bulk  of  gas  is  not  too  much  it 
can  be  placed  in  a  container  through  the  outlet  stop-cock  s  and  sealed; 
all  must  be  done  without  the  least  air  being  allowed  to  enter.  If,  however, 
too  much  gas  remains,  it  may  be  pumped  off  by  a  pump  such  as  Fig.  26. 
When  the  tube  d  is  again  used  as  a  transfer  tube  and  placed  over  the 
inlet  at  a  and  drawn  into  receiver  6,  it  is  then  forced  into  the  bulb  m  by 
lowering  and  raising  mercury  container  e.  m  is  then  placed  in  vessel  j 
containing  liquid  air,  which  causes  the  emanation  to  be  condensed  while  the 
residual  gases  are  not;  they  then  are  pumped  off  by  the  pump,  by  raising 
and  lowering  the  mercury.  When  all  the  gases  have  been  removed  the  tube 
m  is  removed  from  the  liquid  air;  the  emanation  again  turns  the  gas,  and 
is  forced  into  the  small  end  of  tube  m,  when  it  can  be  sealed  off  by  melting 
the  thin  glass  tube. 


96  RADIUM 

After  removal  of  the  greater  part  of  the  residual  gases  the 
emanation,  with  a  very  small,  amount  of  gas,  may  be  placed 
in  any  form  of  apparatus  that  is  desired  (usually  a  small 
capillary  tube),  and  this  small  tube  may  be  employed  in 
exactly  the  same  manner  as  any  of  the  tubes  of  radium. 
For  the  details  of  applying  this  method,  a  person  must  be 
more  skilled  in  the  manipulation  of  the  usual  laboratory 
apparatus  for  gas  analysis;  otherwise  the  transfer  from  one 
piece  of  apparatus  to  the    other  will  be  difficult.    After  the 
emanation  has  been  removed  and  sealed  in  the  applicator 
it  must  be  measured  by  an  electroscope  to  calculate  the 
activity   which  is  obtained  upon  the  basis  of  the  gamma 
radiation.     This  process  must  be  employed  for  each  por- 
tion removed  and  when  the  amount  of  activity  has  once 
been    determined    it  will   conform   exactly  to  the  line   of 
decay  (see  Chart,  Fig.  3),  usual  to  the  emanation,  namely: 
in  four  days  it  will  have  lost  one-half  its  value,   and   in 
fifteen    days    it    will    be   found    to    almost    approach    the 
zero   mark.      Therefore  the  most  effective  period   of  the 
applicator  must  be  in  the  first  four  days;  after  that  time 
it  will  have  lost  most  of  its  value  and  is  of  use  only  in 
superficial  cases.    The  activity  given  off  by  one  of  these 
emanation   tubes    depends   entirely   upon    the   amount   of 
emanation  it  contains  and  may  be  used  in  exactly  the  same 
manner  as  though  it  actually  contained  the  salt  of  radium; 
in  other  words,  if  it  has  been  determined  by  the  electroscope 
that  one  of  these  tubes  equalled  100  mg.  of  radium  element 
three  hours  after  it  was  removed  from  the  radium  salt,  when 
it  gains  its  equilibrium,  from  that  time  on  until  the  fourth 
day    it   would  then  lose  about  one-half  a  milligram  each 
hour;  after  forty-eight  hours  following  its  preparation  it 
would  equal  about  75  mg.  of  radium. 


97 

The  same  filtration,  for  deep  radiation,  is  necessary  with 
the  use  of  these  emanation  applicators,  as  with  any  of  the 
other  forms;  and  the  same  general  lines  must  be  adopted 
for  their  protection,  as  the  salts  of  radium  depend  upon  the 
degeneration  products  of  the  emanation  for  their  activity. 
Removing  the  activity  simply  takes  away  the  active  portion ; 
therefore  in  purpose  they  are  exactly  the  same.  If  all  the 
active  portion  of  the  radium  is  removed,  it  requires  about 
one  month  to  regain  its  activity  or  equlibrium,  and  where 
it  is  the  practice  to  use  the  activity  in  the  form  of  the  emana- 
tion, it  is  usual  to  have  a  large  quantity  of  radium  in  the 
solution,  then,  instead  of  pumping  off  all  the  emanation, 
simply  remove  one-half  the  accumulated  amount.  This  is 
determined  by  practice,  and  can,  in  a  rough  way,  be  guaged 
by  the  amount  of  hydrogen  and  oxygen  formed  from  the 
water  by  the  disintegration  of  radium.  By  this  method 
every  four  days  one-half  the  amount  of  radio-active  value 
can  be  obtained,  instead  of  waiting  for  one  month  before  a 
new  supply  can  be  removed. 

The  advantages  in  the  use  of  the  emanation  are  in  the 
many  forms  of  application  which  can  be  made.  Small,  thin 
tubes,  0.2,  0.3  or  0.4  cm.,  may  be  employed,  or  a  shorter 
one  of  greater  caliber;  small,  flat,  hollow  disks  of  various 
shapes;  practically  any  form  in  which  it  is  possible  to  blow 
the  thin  glass  container. 

INTERNAL   ADMINISTRATION    OF   RADIUM. 

For  the  treatment  of  certain  conditions  of  disease,  radium 
has  been  administered  internally;  the  amount  given  was, 
of  course,  extremely  small;  and  the  form  of  salt  employed 
depended  upon  the  requirement  of  the  case  with  the  effect 

7 


98  RADIUM 

desired.  The  soluble  salts,  the  chloride  or  bromide,  are 
used  dissolved  in  water;  while  the  insoluble  forms,  the  car- 
bonate and  sulphate,  have  been  used,  incorporated  in  some 
powder  or  other  inert  media.  In  solution  they  may  be 
administered  by  mouth  or  given  as  an  injection,  and  under 
proper  precautions,  either  hypodermically  or  intravenously. 
Where  a  decided  reaction  is  desired,  the  last  two  methods 
seem  to  be  preferred.  Its  use  has  been  confined  to  those 
serious  conditions  of  the  blood,  such  as  pernicious  anemia, 
leukemia,  and  general  systemic  disorders  as  Hodgkin's 
disease. 

The  emanation,  however,  has  been  more  widely  employed 
than  the  salts  in  the  internal  administration,  and,  while  its 
activity  is  more  transient,  for  the  treatment  of  milder  forms 
of  disease,  such  as  gout,  it  may  be  preferred,  as  it  causes  less 
reaction.  Then  it  has  this  advantage,  that  only  the  activity 
of  radium  is  used  while  the  source  of  supply  is  always 
intact  and  not  likely  to  be  lost.  Even  where  it  is  desired 
to  use  this  activity  in  massive  doses,  there  are  methods  of 
preparing  solutions  or  mixtures,  which,  if  given  internally, 
would  be  dangerous  to  life.  Therefore  it  is  possible  to  use 
the  emanation  and  meet  all  the  requirements  of  the  actual 
administration  of  any  one  of  the  salts.  The  form  of  ema- 
nator  preferred  for  the  preparation  of  these  solutions  depends 
somewhat  upon  their  use  and  the  strength  of  the  product 
desired.  One  of  the  commonest  forms  of  administration 
is  water  for  drinking  purposes.  This  water  is  prepared 
in  an  apparatus  having  three  compartments;  the  largest 
reservoir  contains  the  water  that  is  charged,  or  being  charged, 
while  a  small  auxiliary  supplies  the  amount  of  water  that 
is  withdrawn;  the  third  compartment  contains  the  radium. 
A  certain  amount  of  water  can  be  drawn  daily;  this  same 


INTERNAL  ADMINISTRATION  OF  RADIUM 


99 


quantity    is    replenished   from   a   reservoir.     The   amount 
taken  from   the  emanation  and  added  to  it,  must  be  in 


FIG.   27 


Emanator  for  charging  drinking  water.     (Lazarus.) 


100  RADIUM 

proportion  to  the  bulk  contained  in  the  charging  chamber, 
so  that  it  will  remove  the  supply  in  proportion  to  the  rate 
of  decay  and  regeneration  of  the  radium.  The  calculations 
are  best  made  upon  the  four-day  basis  of  half  decay ;  that  is, 
the  half  charge,  rather  than  waiting  from  fifteen  days  to  a 
month  for  full  charge.  This  is  the  most  economical  method 
and  the  loss  from  allowing  the  activity  to  disintegrate, 
which  will  be  passed  off  if  not  used,  is  not  so  likely  to 
occur.  The  salt  of  radium  used  in  the  charging  chamber 
must  be  one  of  the  insoluble  forms,  such  as  sulphate,  and  it 
must  be  placed  in  a  vessel  not  likely  to  be  carried  away  by 
the  currents  occasioned  by  the  entrance  or  exit  flows.  For 
this  purpose  it  is  customary  to  employ  one  with  porous  cells, 
which  will  allow  a  slow  percolation  of  the  water  without 
the  likelihood  of  washing  any  of  the  small  grains  of  salt 
with  it. 

By  this  form  of  apparatus  water,  varying  from  2500  to 
10,000  Mache  units  per  liter,  is  easily  obtained,  which  is  the 
strength  usually  employed  for  administration  in  drinking,  or, 
where  larger  quantities  are  made  for  baths,  these  artificially 
prepared  waters  are  used  in  exactly  the  same  manner  as  those 
from  natural  sources  and  have  the  advantage  that,  from  the 
apparatus,  the  supply  is  liable  to  be  more  uniform  and  not 
influenced  by  weather  conditions.  Testing  these  waters  is 
done  by  employing  the  ordinary  gas  electroscope,  and  these 
tests  should  be  made  at  stated  intervals  for  any  correction 
due  to  loss  of  radio-active  material  from  improper  handling. 
But  when  the  quantity  of  radio-activity  contained  in  a 
given  amount  of  water  has  been  once  established,  there  is 
practically  no  variation  from  that  standard,  provided  the 
apparatus  is  systematically  used.  Allowing  the  water  to 
accumulate  or  removing  a  greater  amount  than  should  be 


INTERNAL  ADMINISTRATION  OF  RADIUM       101 

done  under  ordinary  circumstances,  will  materially  alter 
the  uniformity  of  the  supply. 

The  dosage  depends  upon  the  circumstances  and  varies 
from  250  to  20,000  Mache  units  per  day.  It  should  be 
remembered  that  as  the  elimination  of  the  emanation  from 
the  system  is  extremely  rapid,  these  waters  should  be  taken 
slowly.  Baths  should  be  strictly  considered  under  local 
applications,  but  as  the  amount  of  absorption  from  the 
body  of  these  charged  waters  is  sufficient  to  cause  general 
symptoms  and  reactions,  it  therefore  becomes  a  method 
of  internal  administration,  rather  than  a  purely  local  appli- 
cation. Water  for  bathing  purposes  usually  contains  about 
200  to  300  Mache  units  per  liter. 

Charging  waters  with  the  emanation  by  having  a  quantity 
of  uranium  ore  in  it  has  been  practised,  but  as  the  amount 
of  energy  derived  from  these  ores  is  extremely  feeble,  the 
waters  produced  from  this  method  have  very  little  thera- 
peutic value.  On  the  other  hand,  both  drinking  and  bath- 
ing waters  have  been  made  by  the  solution  of  low-grade 
radium  salts,  which  give  the  same  radio-active  qualities 
to  the  water  as  the  emanation,  and,  unlike  the  water  charged 
with  the  emanation,  have  the  property  of  retaining  their 
value  for  years;  the  therapeutic  difference  between  the 
two  being  that  of  the  elimination  from  the  system  of  the 
radium  salt,  which  being  a  solid,  cannot  be  carried  off  by 
the  expired  air. 

Of  all  the  radio-active  preparations,  the  emanation  in 
water  solution  makes  the  ideal  preparation  for  either  hypo- 
dermic or  intravenous  injections.  These  procedures  are 
carried  out  under  the  usual  routine,  due  care  being  taken 
for  the  local  sterilization  of  the  part  and  the  apparatus 
used  in  making  the  injection. 


102  RADIUM 

The  emanation  of  radium,  being  a  gas,  is  frequently  em- 
ployed mixed  with  air  or  oxygen  and  taken  into  the  system 
by  absorption  through  the  lungs.  A  number  of  different 
forms  of  apparatus  have  been  devised,  all  having  for  their 
purpose  a  means  of  diluting  the  emanation  with  air,  and 
conserving  the  waste  which  is  thrown  off  by  the  expired  air. 
In  large  emanatoria  the  operation  is  quite  complicated;  rooms 
are  arranged  so  that  the  emanation  is  pumped  into  them  at  a 
given  rate  per  minute.  The  air  of  the  room,  as  it  is  used,  is 
pumped  out  and  passed  through  water,  lime  and  other  sub- 
stances for  purification,  mixed  with  a  fresh  supply  of  oxygen 
and  returned  to  the  room  with  the  emanation.  In  this  way 
the  air  is  kept  in  a  high  state  of  activity,  which,  if  the  amount 
of  emanation  were  lost  by  natural  ventilation,  would  be  im- 
possible. For  the  use  of  a  single  person  a  form  of  apparatus 
has  been  devised,  which  fulfils  the  purpose  of  these  rooms  or 
cabinets. 

It  consists  essentially  of  the  same  parts,  but  made  upon 
a  very  small  scale,  and  the  use  of  a  motor  to  propel  the  air 
currents  is  unnecessary.  The  principal  difference  is  that 
of  the  inhaler,  which  consists  of  a  cone  adjusted  to  the  mouth 
and  nose.  The  intake  tube  is  arranged  with  suitable  valves 
and  attached  to  the  emanator,  while  the  outlet  tube  is 
connected  with  the  box  for  purifying  the  air.  The  oxygen  is 
supplied  from  a  tank  as  the  current  of  air  passes  in  the  cycle 
and  helps,  with  the  patient's  effort,  to  propel  the  currents 
through  the  apparatus.  With  such  an  apparatus  it  is 
possible  to  use  a  given  amount  of  emanation  for  an  in- 
definite length  of  time.  One  sitting,  as  a  rule,  occupies 
about  three  hours.  In  this  way  the  system  is  saturated 
with  the  emanation  for  a  definite  length  of  time  while  with 
the  other  methods,  such  as  drinking,  bathing  and  packs, 


INTERNAL  ADMINISTRATION  OF  RADIUM        103 


the  body  is  charged  with  this  emanation  during  the  process 
and  for  only  a  short  time'  afterward.  Therefore  by  long- 
continued  inhalations  of  radio-active  air  it  is  possible  to 


FIG.  28 


Emanator  for  charging  air,  with  apparatus  for  supplying  oxygen  and 
removing  the  carbon  dioxide  from  the  expired  air.     (Lazarus.) 

charge  and  keep  charged  the  blood  of  the  body  for  a  con- 
siderable time. 


104  RADIUM 

For  institutions,  where  a  number  of  cases  are  handled 
daily,  special  forms  of  apparatus  have  been  designed,  having 
a  number  of  separate  cells,  and  a  device  for  turning  the  con- 
nection for  one  of  these  cells  to  the  air  tanks,  so  that  a 
certain  amount  of  radiation  can  be  used  from  one  cell,  and 
when  that  supply  is  exhausted  it  is  changed  to  another, 
the  time  and  date  being  registered,  showing  the  amount 
of  gas  that  has  passed  through,  and  giving  a  definite  idea 
of  the  time  required  for  regeneration,  which,  if  totally 
exhausted,  requires  from  fifteen  to  thirty  days.  (See  Fig.  69.) 

It  is  possible  to  construct  a  form  of  apparatus  which  is 
simple  in  design  and  fulfils  the  purpose  almost  to  the  same 
degree  as  one  of  more  elaborate  dimensions.  It  is,  however, 
not  so  economical  in  conserving  the  loss  of  the  emanation, 
and  cannot  be  used  the  length  of  time  that,  under  ordinary 
circumstances,  is  desirable.  This  apparatus  is  easily  con- 
structed from  a  flask  with  the  inlet  tube  dipping  down 
into  it  well  toward  the  bottom;  the  air  entering  should 
be  passed  over  fresh  calcined  lime  to  remove  unnecessary 
impurities,  and  again  connected  with  the  outlet  tube.  There 
should  be  a  drying  apparatus  to  remove  the  vapor  of  water 
and  acid  that  is  taken  up  as  the  air  passes  through  the 
water  containing  the  radium.  (See  Fig.  71.) 

The  amount  of  radio-activity  from  the  different  forms 
of  apparatus  can  be  measured  by  the  ordinary  gas  electro- 
scope and  where  possible  to  follow  the  procedure,  it  should 
be  carefully  carried  out  in  detail,  as  the  variation  from  this 
source  of  radiation  is  somewhat  more  irregular  than  the 
other  means  used  in  the  introduction  of  radiation  into  the 
body  as  a  therapeutic  measure.  The  estimation  of  these 
solutions  and  gases  is  usually  calculated  upon  the  basis  of 
Mache  units.  However,  different  authors  make  their  basis 


INTERNAL  ADMINISTRATION  OF  RADIUM       105 

according  to  the  customs  adopted  in  their  neighborhood,  but 
where  these  comparisons  are  necessary  the  table  of  standards 
will  show  their  relation  to  each  other.  Many  use  the 
"radium  element"  as  a  standard,  and  adopt  the  microcurie 
as  a  unit.  However,  speaking  of  a  solution  having  the 
activity  of  2  microcuries,  does  not  necessarily  indicate  that 
radium  is  present  to  that  amount;  the  activity  may  be  due 
to  the  emanation  alone  having  the  value,  with  absolutely 
no  trace  of  radium. 


CHAPTER  VI. 
THORIUM. 


Practical  Use  in  Medicine — Difficulties  of  Determining  Actual  Amount 
of  Radiation — Local  Application — Methods — Use  in  Internal  Medicine — 
Thorium  X — Emanation — Radiothorium — Conclusions. 


THE  active  portion  of  the  thorium  group  is  usually  com- 
mercially known  as  mesothorium;  it  often  contains  a  list 
of  disintegration  products  exactly  the  same  as  commercial 
radium.  Unlike  radium,  however,  it  is  by  no  means  as  regular 
in  its  course,  and  in  fact  wide  variations  exist  in  its  rapid 
disintegration.  A  mesothorium  product  may  gain  some 
activity  during  the  first  year.  It  then  degenerates  until 
between  four  and  four  and  one-quarter  years,  when  it  has 
lost  about  one-half  its  activity  and  then  gradually  declines 
until  between  ten  and  twenty  years,  it  has  lost  all  its  activity. 
There  is,  however,  considerable  irregularity  in  all  these 
thorium  products,  due  to  the  impurities  and  the  irregular 
methods  of  separating  the  mesothorium  I,  mesothorium  II 
and  radiothorium  from  the  original  thorium.  So  far,  the 
processes  of  separation  are  evidently  far  from  being  perfect. 
As  most  of  the  products  are-  handled  by  large  manufacturers 
there  has  been  very  little  disposition  to  consider  their  by- 
products. The  following  table  gives  the  contrast  between 
the  regularity  of  the  radium  group  and  the  very  irregular 
group  of  thorium  elements: 


THORIUM 


107 


RADIUM  GROUP. 


Element. 

Radium 

Emanation 

'g         fRadium  A 

§••5. &  1  Radium  B 

1  2  g  [Radium  Ci-C2 

J-g-g    Radium  D 

RadiumfEi 

Radium\E2 

Radium  F 


Radiation. 

Period  of  i  life. 

*,0 

2000.0  years 

a 

3  .  85  days 

Commercial 

a 

(S 

a,  0,  7, 

3.0    min. 
26.7    min. 
19.5    min. 

•radium  as  it  ages, 
portion  of  D,  etc. 

a 

15.0    years 

0,7 

4  .  8    days 

a 

140  .  0    days 

THORIUM  GROUP. 


Thorium 

Mesothorium  I 
Mesothorium  II 
Radiothorium 

Thorium  X 
Thorium  emanation 
(Thorium  A 
s  J  Thorium  B 

35%/  \65% 
[Thorium  C,  Thorium  C, 

I 

J, 

Thorium  C2 
Thorium  D 


Thirty   million 
years 

5.5    years  ] Commercial 
6.2    hours  j-mesothorium,    a 
2 . 0    years  j  varying   amount 
of    these    three, 
with  active  pro- 
duct varying  ac- 
cordingly 


3.6    days 
53 . 0    sec. 

0. 14  sec. 
55.0    min. 


TTJoooooo^oooo  sec- 


3. 1  min. 


The  variation  of  the  life  of  these  mesothorium  products 
depends  upon  the  proportion  of  mesothorium  I  with  a 
half-period  of  average  life  of  5.5  years;  mesothorium  II 
with  a  half-period  of  average  life  of  six  hours;  and  radio- 
thorium  with  a  half-period  of  average  life  of  two  years. 

The  varying  proportions  of  these  elements,  with  other 
ordinary  impurities  common  to  the  radio-active  elements, 
constitute  the  commercial  product.  One  of  the  commonest 
impurities,  which,  under  ordinary  circumstances  is  not  objec- 
tionable, is  radium,  and  most  of  these  products  contain  it  in 
proportions  of  from  12  per  cent,  to  25  per  cent.  Reference 
was  made  to  this  fact  in  the  chapter  dealing  with  the  chem- 


108  THORIUM 

istry  and  physics  of  the  elements;  from  a  medical  point  of 
view,  this  cannot  be  regarded  as  a  serious  objection,  con- 
sidering, at  the  end  of  the  period  of  disintegration  of  the 
thorium,  the  specimen  will  contain  a  small  amount  of  radium. 

The  thorium  preparations  are  much  more  active  than  the 
radium  preparations,  due  to  the  more  rapid  disintegration; 
but  actual  comparisons  are  impossible,  due  to  the  irregular 
mixture  of  the  thorium  products.  The  basis  of  all  measure- 
ments is  exactly  the  same  as  radium,  using  the  "radium 
element"  as  the  standard,  and  making  comparisons  from  it 
in  exactly  the  same  manner.  However,  on  account  of  the 
activity  of  these  thorium  elements,  the  standards  are 
often  exceeded.  The  radiation  of  these  preparations  varies 
considerably  both  in  regard  to  the  proportion  and  quality 
of  a,  ft,  and  7  and  also  in  the  proportion  and  quality  of  the 
different  forms  of  each  ray  existing  in  each  specimen.  The 
highest  range  of  alpha-rays  is  given  off  by  thorium  C, 
its  penetration  being  about  8  c.c.  of  air,  and  the  same  is 
true  with  the  gamma-radiation,  which  from  some  of  these 
thorium  elements  has  an  extreme  power  of  penetration. 
Therefore,  when  the  specimen  is  measured,  the  quality  of 
each  form  of  radiation  should  be  given. 

Local  application  of  mesothorium.can  be  made  in  exactly 
the  same  manner  as  radium,  either  in  the  form  of  naked 
salts  or  protected.  Naked  specimens  of  mesothorium  may 
be  employed,  but  if  the  salts  are  of  high  activity  due  care 
must  be  given  to  the  protection  of  the  part  to  which  the 
application  is  made,  for,  should  any  of  the  small  grains 
adhere  to  the  surface  exposed  to  radiation  serious  conse- 
quences are  likely  to  follow.  Weak  specimens  may  be  in- 
corporated in  materials  such  as  wool,  cloth  or  silk,  and  made 
into  underwear  or  bandages,  where  a  general  mild  radiation 


THORIUM  109 

is  desired.  Small-sized  applicators  made  of  silk,  wool  or 
other  fabric,  may  be  applied  in  a  varnish,  but  the  salt, 
under  these  circumstances,  must  be  strong  enough  to  com- 
pensate for  the  loss  of  the  alpha-radiation,  lost  by  the  thin 
covering  of  the  varnish.  These  applicators  are  intended 
for  deeper  penetration.  Local  application  of  mesothorium 
may  be  made  as  a  pack  or  mud  cataplasm,  or  a  bath;  but 
as  a  general  rule  the  thorium  salts  are  more  irritating  and 
in  large  amounts  are  toxic;  therefore,  in  making  these  local 
applications,  aside  from  the  radio-activity,  caution  must 
be  used,  otherwise  toxic  symptoms  of  general  thorium  poison 
may  follow. 

In  the  form  of  protected  applicators,  the  same  general 
principles  hold,  as  in  those  made  for  radium.  Varnished 
applicators  under  the  same  general  principles  or  placed  in 
capsules  of  glass  or  aluminium,  or  the  concaved  button  with 
a  mica  covering;  in  fact  any  design  suitable  to  the  particular 
style  of  work  expected  from  the  applicator  may  be  used. 

On  account  of  the  very  high  activity  of  some  of  these 
specimens  of  mesothorium,  they  must  be  carefully  guarded 
with  filters  and  protected  from  the  amount  of  secondary 
radiation  that  must  necessarily  occur  where  the  activity  is 
so  intense.  Some  specimens  have  been  rated  as  being  three 
or  four  times  as  strong  as  the  same  amount  of  radium.  This 
rating  is  purely  relative,  from  a  practical  point  of  view,  and  on 
account  of  its  rapid  degeneration  a  year's  variation  is  con- 
siderable. However,  when  these  specimens  are  at  their  point 
of  highest  activity  they  must  be  guarded  in  exactly  the  same 
manner  as  extremely  large  amounts  of  high-percentage 
radium. 

On  account  of  this  activity  many  authorities  contend 
that  mesothorium,  used  in  well-protected  capsules,  filtered 


110  THORIUM 

with  several  millimeters  of  lead  or  platinum,  is  decidedly 
more  efficient  than  radium;  this  depends,  to  some  extent 
upon  the  specimen  of  mesothorium.  Should  the  radiation 
be  of  high  quality  the  extreme  amount  of  radiation  in  the 
small  mass  should  give  an  application  of  a  remarkably 
high  degree  of  efficiency. 

The  emanation  of  thorium  has  a  period  of  life  of  seventy- 
six  seconds  which  does  not  permit  its  use  in  any  such  manner 
as  the  corresponding  gas  from  radium ;  this  period  of  rapid 
change  does  not  allow  sufficient  time  for  the  proper  handling 
or  manipulation  from  a  practical  standpoint.  The  element 
in  the  thorium  group  corresponding  to  the  radium  emanation 
in  usefulness,  is  thorium  X,  which  has  about  the  same  period 
of  life,  and  while  it  does  not  possess  the  physical  properties 
that  favor  the  easy  manipulation  of  radium  emanation,  it 
seems  to  be  of  value  particularly  for  internal  administration, 
for  which  it  is  employed.  Commerically,  thorium  X  has 
been  placed  upon  the  market  under  several  trade  names, 
usually  in  solution  and  contained  in  small  sealed  ampullas, 
containing  5  to  30  cm.,  varying  in  strength  according  to  the 
purpose.  On  account  of  its  nature  and  the  difficulty  of 
manipulation  from  a  chemical  stand-point,  it  does  not 
permit  its  production  except  in  laboratories  especially 
equipped  for  this  purpose. 

From  these  ampullas  containing  the  thorium  X,  a  solu- 
tion of  varying  standards  can  be  made,  the  rating  as  usual 
being  in  comparison  with  "radium  element."  As  a  general 
medicine  it  may  be  administered  three  times  a  day  in  the 
equivalent  of  1  to  100  electrostatic  units  or  from  1000  to 
10,000  Mache  units;  even  in  larger  doses  where  the  circum- 
stances demand.  The  concentration  of  activity  is  a  peculiar 
feature  of  thorium  X  preparations. 


THORIUM 


111 


The  amount  of  energy  from  1  c.c.  of  solution  may  run 
as  high  as  1,000,000  Mache  units  which  equal  about  ToTonr 
of  a  milligram  of  thorium  X  element. 


FIG.  29 


1  tU 

100 
90 
80 
70 
60 
50 
40 
30 
20 
10 
0 

£2 

\| 

\ 

\ 

\ 

- 

\ 

\ 

\ 

\ 

\ 

\ 

• 

X 

\ 

<s 

\ 

>^ 

^^ 

1          2          3          4          5          6          7          8          9         10         11         12         1 

DAYS 


Diagram  showing  the  decay  of  thorium  ~K. 


Where  it  is  desired,  the  solution  of  thorium  X  can  be 
carefully  evaporated  with  some  inert  substance  such  as 
sand,  and  the  radio-active  element  becomes  incorporated 
in  this  material.  This  fine  sand  may  then  be  applied  locally 
or  given  internally  in  exactly  the  same  manner  as  the  solu- 


112  THORIUM 

tion.    Its  period  of  life  is  not  altered  in  any  way  except  for 
the  time  lost  in  the  preparation  of  the  material. 

The  usual  method  of  employing  thorium  X  is  either  hypo- 
dermically  or  intravenously  and  under  these  circumstances 
large  doses  are  administered  in  such  diseases  as  pernicious 
anemia  and  leukocythemia,  and  where  enormous  doses  are 
employed,  the  cases  must  be  kept  under  careful  observation, 
as  the  changes  in  the  blood  elements  are  apt  to  be  profound. 
Instances  have  been  reported  where  death  is  supposed  to 
have  resulted  from  the  effects  of  these  radio-active  elements. 
Injections  are  made  under  the  ordinary  routine  measures 
of  sterilizing  the  parts  and  the  syringes  used  in  the  procedure. 
They  may  be  administered  daily,  but  it  is  far  more  common 
to  give  one  injection  and  then  wait  a  few  days  before  giving 
another,  noting  carefully  the  effect,  and  increasing  or  decreas- 
ing the  following  injection  according  to  the  demands  of  the 
individual  case.  The  quantity  of  thorium  X  contained  in  a 
solution  holds  exactly  the  same  relation  to  thorium  as  the 
emanation  of  radium  does  to  radium;  it  has  about  the  same 
degeneration  period  or  curve  decay.  Being  a  solid,  it  is 
not  eliminated  from  the  body  so  rapidly  as  the  emanation  of 
radium,  and  being  retained  within  the  system  it  disinte- 
grates into  the  emanation,  which  is  possibly  to  some  extent 
eliminated  by  the  lungs.  It  therefore  has  some  influence 
over  the  respiratory  system. 

Where  it  is  desired  to  use  the  thorium  emanation  for 
inhalation,  it  must  be  obtained  directly  from  thorium  X, 
by  arranging  an  apparatus  to  hold  a  solution  of  this  element 
and  drawing  air  through  it  in  exactly  the  same  manner  as 
when  the  radium  solution  is  employed.  Under  these  circum- 
stances the  short  period  of  life  must  be  considered  and 
allowance  must  be  made  for  it.  Solutions  of  thorium  X 


THORIUM  113 

must  necessarily  be  rapidly  exhausted  of  their  emanation, 
which,  on  the  other  hand,  rapidly  recovers.  When  the 
radium  solution  was  exhausted  of  its  emanation  it  was 
necessary  to  wait  four  days  for  the  period  of  one-half 
recovery,  or  if  exhausted,  fifteen  to  thirty  days  for  complete 
recovery;  for  the  thorium  product  the  period  is  slightly  over 
one  minute.  But  the  period  of  life  being  such  a  limited 
space  of  time,  the  amount  present  is  always  extremely  small 
(see  Fig.  71). 

Where  these  gas  emanators  are  to  be  used  for  an  ex- 
tended length  of  time,  they  should  contain  a  solution  of 
mesothorium  or  radiothorium,  which,  once  having  gained 
its  equilibrium,  keeps  the  apparatus  charged  with  thorium 
X  which  degenerates  into  the  short-lived  emanation. 

Under  some  conditions  radiothorium  has  been  used  alone, 
but  the  difficulty  of  obtaining  this  element  in  a  fairly  pure 
state  does  not  permit  its  general  adoption.  The  supply 
is  extremely  limited,  due  to  the  difficulty  of  separating  it 
from  the  elements  of  the  thorium  group  and  also  from  radium. 
The  time  of  disintegration  stands  between  the  commercial 
mesothorium  products  and  commercial  thorium  X.  It 
has  the  advantage  that  it  does  not  disintegrate  so  rapidly  as 
the  latter  and  decidedly  faster  than  the  former,  and  for 
use  as  a  general  medicine  under  some  conditions  is  desirable. 

\Vhile  the  elements  of  the  thorium  group  are  by  no  means 
so  well  defined  as  those  of  radium,  they  serve  a  purpose  which 
some  skilful  observers  consider  superior  under  some  circum- 
stances. For  instance,  the  high  activity  and  the  extreme 
penetrating  qualities  of  the  different  rays  warrant  their  use 
locally  in  the  treatment  of  deep  tumors,  where  a  large 
amount  of  radiation  is  desired.  Commercially  the  thorium 
elements  have  been  placed  upon  the  market  under  such 
8 


114  THORIUM 

trade  names  as  mesothorium,  radiothorium,  and  thorium  X. 
The  difference  in  the  mixture  of  mesothorium  and  radio- 
thorium,  mainly  affects  only  the  life  of  the  product.  While 
thorium  X  is  of  very  short  duration  and  can  only  be  obtained 
in  close  proximity  to  the  source  of  supply,  its  value  is  prin- 
cipally for  internal  medication,  where  it  will  be  found  that 
the  thorium  products  are  much  more  active  than  those  of 
radium. 

This  activity  can  easily  be  figured  by  comparing  them, 
mass  for  mass,  with  the  time  of  disintegration,  the  force  being 
the  same,  but  eliminated  in  a  very  much  shorter  space  of 
time.  By  their  activity  and  the  length  of  time  they  are 
incorporated  in  the  tissue,  they  give  rise  to  violent  systemic 
disturbances,  far  more  noticeable  than  those  under  similar 
conditions  with  radium.  When  these  thorium  products  have 
once  been  introduced  into  the  system,  their  elimination  is 
much  slower.  There  may  also  be  the  underlying  fact  that 
thorium,  as  used  in  general  medicine,  is  not  free  from  toxic 
effect  other  than  might  be  expected  from  the  point  of  radio- 
activity; and  beside  the  general  adaptability  of  the  radium 
emanation,  with  its  regular  action  and  easy  manipulation, 
gives  it  in  many  respects  a  preference  over  the  use  of 
thorium. 


CHAPTER  VII. 
ACTINIUM  AND  URANIUM. 


Practical  Use  of  Actinium  in  Medicine — Comparison  with  Radium  and 
Thorium — Methods  Used  for  Local  Application — Use  in  Internal  Medicine 
— Uranium — Local  Use — Uranium  X — Comparison  with  Other  Radio- 
active Elements. 


Actinium. — The  use  of  actinium  in  general  medicine  has 
been  extremely  limited,  due  to  the  difficulty  of  procuring 
a  sufficient  quantity  for  practical  purposes.  It  seems  tp 
be  even  more  sparsely  distributed  through  the  earth's  crust 
than  either  of  its  two  prototypes,  and  the  difficulty  of  sepa- 
ration gives  little  encouragement  for  future  development. 
Most  instances  where  actinium  has  been  employed  were  in 
conjunction  with  some  well-developed  scientific  laboratory 
and  even  there  to  a  limited  extent.  But  where  it  has  been 
used  it  seems  to  be  a  counterpart  of  thorium  rather  than  of 
radium.  The  rapidity  of  the  disintegration  of  some  of  the 
elements  is  even  greater  than  thorium,  while  the  radiation 
from  it  seems  to  be  less  desirable.  A  comparison  may  be 
interesting: 

$-rays;  -y-rays; 

mm.  of  aluminium  for  cm.  of  lead  for 

absorption  of  %  radiation.  absorption  of  %  radiation. 

Radium  B  0.09 

C  0.5  1.38 

F  0.16 

Mesothorium  0.34  1.1 

Thorium          C  0.05 

D  0.441  1.5 

Actinium         Ci  (about)  0.04 

D  0.24  0.57   to  possibly  0.8 


116  ACTINIUM  AND   URANIUM 

This  table  gives  the  comparative  life  of  the  actinium  group : 


Period  of  i  life.  Radiation. 

Actinium       ...  30  years  (?)  No    rays 

Radio-actinium         .  19 . 5      days  a  to  j8 

I 
Actinium  X  ...  10.2      days  a 

I 
Emanation    ...  3.9      seconds  a 

I 
Actinium  A  ...  0 . 002  seconds  a 

Actinium  B  .  36 . 1      minutes  /3 

Actinium       ...  2.15    minutes  a 

/   4 
c,    c, 

Actinium  D  .  5.10    minutes  0  and  7 


Actinium  degenerates  85,000  times  faster  than  radium, 
therefore  the  amount  of  force  is  enormous,  but  the  quality 
of  the  radiation  does  not  seem  to  compare  favorably 
with  the  other  two  elements.  It  is  the  rarest  of  the  very 
active  disintegrating  series  and  appears  to  be  of  the  least 
value  from  a  medical  stand-point. 

Where  actinium  has  been  employed  in  the  treatment  of 
local  disease,  it  has  been  applied  in  applicators  in  precisely 
the  same  manner  as  was  radium  and  thorium.  Since  the 
volume  of  activity  is  even  greater  than  thorium,  and  on 
account  of  the  predominance  of  low  radiation  filtration  is 
absolutely  necessary,  compresses  and  other  forms  of  direct 
local  application  have  been  made  from  actinium  X,  which 
has  a  usefulness  of  about  ten  days.  Actinium  X  compares 
favorably  with  thorium  X,  but  with  a  life  that  is  almost 
three  times  as  long.  As  the  emanation  of  actinium  has  a 
life  of  only  about  four  seconds,  its  use  for  bathing  or 
drinking  water  must  be  prepared  from  actinium  X  which 
produces  the  very  rapid  changing  emanation. 


ACTINIUM  117 

The  emanation  of  actinium  is  far  more  soluble  in  water 
than  the  other  two,  the  coefficient  being  radium  emanation, 
0.25;  thorium  emanation,  1;  actinium  emanation,  2.  This 
may  explain  some  difference  in  the  physiological  action 
manifested  by  the  absorption  of  it  by  the  tissue  juices. 

FIG.  30 


Radiograph  produced  by  the  effect  of  a  solution  of  actinium  X  of  200 
electrostatic  units  injected  into  a  mouse,  which  was  killed  30  seconds  after 
the  injection,  placed  upon  the  plate,  and  left  for  15  hours.  The  activity 
seems  to  be  more  especially  coryfined  to  the  liver,  gastro-intestinal  canal, 
and  the  osseous  system.  (Lazarus,  Med.  Klinik,  No.  21,  1913.) 


Actinium  X,  supplied  from  the  actinium  with  a  direct 
parent  of  radio-actinium,  may  be  used  in  charging  solutions 
in  exactly  the  same  manner  as  thorium  X,  its  physiological 
action  and  use  being  more  or  less  similar.  The  solution 
may  be  administered  by  the  mouth  or  any  of  the  natural 
passages,  as  a  local  injection,  or  what  seems  to  be  most 
common,  either  hypodermically  or  intravenously,  and  in 
relatively  high  doses,  from  50,000  Mache  units  to  150,000 
Mache  units  per  day. 

On  account  of  the  difficulty  of  dissolving  actinium  X 


118  ACTINIUM  AND   URANIUM 

when  it  is  to  be  employed  in  the  form  of  a  subcutaneous 
injection,  the  solution  should  be  filtered;  otherwise  solid 
particles  introduced  into  the  system  may  produce  trouble 
from  local  areas  of  undesirable  activity.  It  has  been  em- 
ployed hypodermically  in  the  treatment  of  cases  of  anemia 
and  leukemia,  while  baths  and  drinking  water  have  been 
used  in  rheumatism,  gout,  arteriosclerosis,  sciatica,  corpu- 
lency, and  effects  of  chronic  poisoning. 

URANIUM. 

Uranium  and  its  salts  are  scarcely  to  be  considered  in  the 
same  group  as  these  valuable  elements,  yet  they  undoubt- 
edly possess  some  virtue  which  must  not  be  overlooked. 
Reports  have  been  made  where  minerals  of  uranium  were 
placed  over  the  surface  of  ulcerations  of  various  kinds,  par- 
ticularly those  due  to  senile  keratosis,  epithelioma,  and  lupus 
vulgaris,  and  their  application  was  followed  by  healing.  In 
some  of  these  instances  crystals  of  the  native  minerals 
were  employed;  and  here  possibly  some  doubt  must  be 
raised  as  to  whether  the  efficiency  was  due  to  uranium  alone 
or,  under  these  circumstances,  to  the  radium  and  such  by- 
products as  are  usually  contained  in  these  native  crystals. 

Reports  have  also  been  made  where  the  element  uranium  X 
was  used  in  the  treatment  of  similar  conditions.  Uranium 
X  can  be  prepared  from  a  solution  of  uranium  acetate  or 
better,  nitrate,  to  which  a  small  quantity  of  ferric  chloride 
has  been  added;  the  iron  salt  is  then  precipitated  by  the 
addition  of  a  small  quantity  of  ammonia  hydroxide,  causing 
a  precipitation  of  the  iron  only  as  iron  hydroxide,  to  which 
adheres  the  uranium  X.  The  solution  is  then  filtered  and 


URANIUM  119 

the  radio-activity  of  the  uranium  salt  is  thus  carried  off 
by  the  flakes  of  the  iron  precipitate.  This  precipitate  can 
be  applied  to  the  ulcers  directly  as  a  paste  or  mixed  with 
some  other  inert  powder  or  salve. 

Minerals  containing  uranium  have  been  placed  in  water 
with  the  idea  of  giving  it  a  degree  of  radio-activity,  which 
they  do  only  to  a  very  limited  extent;  the  charge  which  is 
given  is  due  entirely  to  the  elements  radium,  thorium,  and 
actinium  contained  as  impurities.  Where  this  method  is  to 
be  employed  under  such  circumstances,  it  is  important  to 
have  the  mineral  matter  in  a  very  finely  powdered  state 
and  frequent  agitation  of  the  water  is  necessary.  The  small 
amount  of  emanation  given  off  by  these  minerals  is  extremely 
limited,  and  if  it  is  confined  within  a  mass  of  mineral  matter 
which  does  not  allow  it  to  come  in  contact  with  the  water, 
that  proportion  of  emanation  eliminated  under  the  surface 
of  each  piece  of  rock  will  not  be  absorbed  by  the  water, 
but  will  remain  occluded  by  the  mass,  and  undergo  further 
disintegration  passing  into  other  elements. 

The  water  made  under  these  conditions  is  of  very  low 
radio-activity,  and  from  a  medical  point  of  view  would 
appear  to  be  absolutely  of  no  value.  The  therapeutic 
properties  of  uranium,  as  used  in  general  medicine,  cannot 
be  ascribed  to  its  radio-activity;  while,  from  the  application 
of  different  uranium  products  locally,  there  is  undoubted 
evidence  that  its  radiation  has  produced  beneficial  results 
in  numerous  instances. 


CHAPTER  VIII. 
PHYSICAL  PROPERTIES  OF  APPARATUS. 

The  Basis  of  Construction — Distribution  of  the  Salts — Toiles — Naked 
Salts  — Applicators  —  Radiodes— Covers  —  Maturation  —  Cashe  —  Filters  or 
Screens — Applicators — "Cross  Fire" — Preparation  of  Apparatus — Prepara- 
tion of  the  Patient — Surface  Cases — Deep  Cases — Cavities — Implantation — 
Use  of  Radio-active  Wax— Use  of  Emanation  in  Applicators. 

THE  two  principal  sources  of  radiation  are  from  the  salts 
of  radium  and  thorium,  while  actinium  possesses  a  very 
high  ratio  of  useful  rays;  at  the  present  time  this  element 
is  so  difficult  to  obtain  that  it  is  hardly  to  be  considered 
for  practical  use.  Uranium,  on  the  other  hand,  is  easily 
obtained,  but  the  amount  and  quality  of  radiation  derived 
from  it  is  so  small  and  lacking  in  penetrability  that  its  scope 
has  been  extremely  limited  and  few  reports  have  been  made 
upon  it. 

Applicators  of  various  forms  have  been  recommended  by 
different  operators,  most  of  them  having  designs  of  their  own, 
more  or  less  modified  to  suit  the  peculiar  class  of  work  for 
which  they  are  employed.  However,  the  following  general 
points  must  be  considered  in  the  mounting  of  all  radio- 
active salts  in  the  preparation  of  these  applicators. 

1 .  The  activity  of  the  radio-active  salt. 

2.  Weight  of  the  salt  and  the  proportion  of  impurities 
therein  contained. 

3.  Impurities. 

4.  Surface  and  size  of  the  grains  of  salt. 


PHYSICAL  PROPERTIES  OF  APPARATUS         121 

5.  Distribution. 

6.  Age  of  salt. 

7.  The  quality  and  quantity  of  the  fixative  substance  or 
wall  of  a  capsule. 

The  activity  of  the  radio-active  salt  must  be  considered 
in  relation  to  the  mount,  for  if  a  very  feeble  salt  is  mounted 
in  a  capsule,  very  little  energy  will  escape,  and  such  a  prepa- 
ration would  be  useless;  on  the  other  hand,  this  salt  could 
be  mounted  upon  a  flat  applicator  with  a  thin  varnish,  and 
in  this  way  prove  quite  useful  in  surface  conditions,  deriving 
its  strength  mainly  from  the  low  rays. 

The  weight  of  the  radio-active  salt  and  proportion  of 
impurities  alter  its  relative  usefulness,  in  several  ways. 
For  instance,  if  a  very  strong  radiation  of  the  7  (gamma) 
ray  is  required  for  the  introduction  into  cavities,  it  is  desir- 
able to  have  it  in  as  compact  form  as  is  possible,  having  the 
radiation  emanate  from  a  compact  mass.  If  the  7  (gamma) 
rays  alone  are  desired,  and  the  amount  of  space  not  to  be 
considered,  then  a  reasonably  large  amount  of  debris,  con- 
tained in  these  salts,  is  not  objectionable;  in  other  words,  if 
we  desire  a  small  compact  mass,  a  60  per  cent,  or  a  high  grade 
salt  must  be  used,  while  a  10  per  cent,  salt  containing  the 
same  amount  of  pure  radium  wrill  give  off  the  same  amount 
of  gamma  radiation,  but  the  bulk  would  be  many  times  as 
great. 

If  the  low  rays  are  to  be  used,  which,  as  a  rule,  are  not 
desirable,  then  the  amount  of  impurities,  the  kind  of  impuri- 
ties, the  surface  and  size  of  the  grains  of  these  radio-active 
salts  are  of  importance.  If  all  the  salt  was  contained  in  one 
spherical  mass,  that  portion  of  the  salt  in  the  centre  would 
lose  a  fair  proportion  of  its  low  rays,  the  mass  itself  acting 
as  a  filter,  and  in  this  way  the  low  rays  wyould  be  occluded 


122         PHYSICAL  PROPERTIES  OF  APPARATUS 

within  their  own  generator.  If  this  same  mass  is  spread 
over  a  surface  larger  in  proportion  than  the  surface  of  the 
sphere,  or  in  fact  in  an  extremely  thin  layer,  then  all  the 
rays  generating  from  the  thin  surface  of  the  salts  escape 
freely,  not  being  obstructed  by  their  own  mass  or  that  of 
impurities.  Usually,  however,  low-grade  salts  are  used  for 
these  surface  applicators,  as  the  relative  proportion  of  low 
ray  is  so  much  greater  than  the  high  rays  that  the  small 
proportion  occluded  by  impurities  is  fully  compensated  by 
their  great  preponderance. 

Maturation. — The  age  of  these  salts  is  always  a  vital  point. 
It  must  be  remembered  that  time  is  required  for  these  fresh 
preparations  to  gain  their  equilibrium.  This  varies  with  the 
element  used  and  if  thorium  is  the  base,  its  time  of  degen- 
eration must  also  be  taken  into  consideration. 

The  quality  and  quantity  of  the  fixative  agent  or  the  walls 
of  the  container  give  rise  to  the  same  obstruction  as  impur- 
ities of  the  salts  and  here  again  the  material  used  must  be 
considered  in  relation  to  the  quality  and  quantity  of  the 
rays  desired. 

Radio-active  salts  mounted  upon  silk,  wool,  or  other  flat 
material  have  been  given  the  name  of  "Toiles."  The  salt 
so  mounted  is  usually  of  low  grade,  and  most  of  the  activity 
is  derived  from  the  low  rays;  it  must  be  remembered  that 
as  a  rule  they  are  extremely  irritating,  therefore  stimulat- 
ing. The  soft  and  yielding  nature  of  these  "toiles"  allows 
them  to  conform  to  the  irregular  surface  of  the  body,  and 
the  size  can  be  varied  accordingly;  such  articles  as  bandages 
and  undergarments  may  also  be  charged. 

These  materials  may  be  covered  with  a  thin  varnish  in 
which  either  the  soluble  salts  of  radium  or  thorium  have  been 
dissolved  or  the  insoluble  salts  well  emulsified;  the  latter, 


APPLICATORS 


123 


however,  do  not  give  the  even  distribution  of  the  soluble 
salts,  but  there  is  less  chance  of  loss  should  these  applicators 
become  accidentally  immersed  in  some  fluid. 

Great  care  must  be  exercised  in  handling  these  applicators, 
as  even  a  small  amount  of  radium  or  thorium  has  some 
peculiar  action  upon  the  material  that  causes  them  in  time 
to  become  extremelv  brittle. 


FIG.  31 


FIG.  32 


FIG.  33 


Compare  these  applicators  with  Fig.  33. 
Notice  the  dark  color  due  to  age. 


Round  applicators  covered 
with  thin  mica;  each  contain 
about  1  nig.  radium  element. 
They  have  a  very  limited  sphere 
of  usefulness. 


Applicators. — A  shallow  button  of  metal,  hard  rubber,  horn, 
ebony,  or  other  material  of  kindred  nature,  wyith  a  cap  of 
mica  that  is  easily  removed,  is  frequently  employed  for 
the  application  of  these  salts  to  surface  conditions  where  the 
part  to  be  treated  is  readily  accessible.  It  is  rarely  necessary 
to  remove  the  cap  and  use  the  naked  radium  or  thorium ;  the 
liability  to  loss  from  careless  manipulation  is  too  great 
to  warrant  this  procedure.  Besides,  the  chance  of  a  few 
grains  adhering  to  the  skin  of  the  patient  might  result  in  a 
disastrous  burn  at  the  site  of  application. 

In  some  instances  celluloid  has  been  used  for  covering 


124 


PHYSICAL  PROPERTIES  OF  APPARATUS 


these  specimens  and  where  it  is  employed  it  should  be 
remembered  that  the  radio-activity  of  these  salts  will  in 
time  cause  it  to  become  extremely  brittle.  Thin  mica  has 
about  as  little  obstructive  power  to  these  rays  as  is  con- 
sistent with  safety;  and  the  action  of  these  salts  does  not 
seem  to  cause  any  material  degeneration,  except  that  like 
other  substances  it  is  colored  to  some  extent  by  age.  This 
in  no  way  interferes  with  the  penetration  of  these  rays, 
while  it  does  obstruct  vision. 

FIG.  34 


Square  applicator. 


A  form  of  applicator  that  is  found  to  be  very  serviceable 
and  can  be  made  in  many  forms,  is  a  disk  of  metal  or 
hard  rubber,  to  which  the  radio-active  salt  is  fixed  by 
means  of  a  varnish.  The  varnish  causes  it  to  adhere 
to  the  applicator  and  furnishes  ample  protection  to  the 
radio-active  salt.  It  must  be  carefully  observed  from 
time  to  time,  for  like  all  organic  substances,  the  varnish 
in  time  becomes  brittle,  due  to  the  radio-activity,  and 
is  likely  to  break  or  fall  a  way  from  the  surface  to  which 
it  is  attached.  In  this  way  some  of  the  salt  is  likely  to  be 


VARNISH  APPLICATORS  125 

lost,  therefore,  from  time  to  time,  they  must  be  re-coated. 
The  nature  of  the  varnish  allows  them  to  be  easily  cleaned 
with  warm  water,  bichloride  of  mercury,  or  formalin,  but 
not  with  alcohol  or  other  solvents  of  varnish.  The  shape 
of  these  applicators  is  of  some  importance;  formerly  they 
were  usually  round,  and  about  2  to  5  cm.  in  diameter. 
The  round  applicator  has  lately  given  way  to  the  square 
one,  wrhich,  if  several  are  to  be  applied,  may  be  placed 
advantageously  side  by  side,  in  this  way  covering  the 
surface  completely. 

Varnish  Applicators. — These  applicators  must  be  carefully 
prepared  so  as  to  have  an  even  distribution  of  the  radium 
salt.  If  there  is  a  greater  portion  at  one  place  than 
another,  the  amount  of  radiation  will  be  more  or  less  im- 
proportionate  to  the  quantity  of  salt.  In  the  preparation 
of  these  disks  they  must  be  properly  cleansed  and  a  coat  of 
varnish  applied,  wThich  when  dry  should  be  followed  by  the 
application  of  several  more  coats  in  which  the  radium  salt 
has  been  dissolved;  always  allowing  one  coat  to  dry  before 
applying  the  next.  After  the  radium  varnish  has  been  applied 
and  allowed  to  dry,  several  coats  of  plain  varnish  are  used 
to  protect  the  radium  salts  from  injury.  Drying  should  be 
complete,  and  is  best  done  in  a  hot  water  oven;  this  causes 
the  resins  of  the  varnish  to  set  hard  and  firm,  and  if  this 
process  has  been  carefully  followed  there  is  very  little  danger 
of  injury. 

This  form  of  applicator  may  be  used  upon  the  surface,  for 
dermal  conditions,  or  for  deep  radiation  with  filters  of  suffi- 
cient material  to  obstruct  the  low  rays,  provided  the  salts 
give  off  a  fair  proportion  of  high  rays.  Where  it  is  desired 
to  increase  the  amount  of  surface  in  one  of  these  applicators 
for  a  large  proportion  of  low  radiation,  a  piece  of  wool  or 


126          PHYSICAL  PROPERTIES  OF  APPARATUS 

some  material  having  a  loose  texture  may  be  placed  in  the 
bottom  of  the  disk  and  the  varnish  then  allowed  to  cover 
the  fabric  without  loading  it  down.  In  this  way  the  uneven 
surface  of  the  fabric  increases  the  radio-active  area.  The 
radiation  from  these  applicators  is  usually  reckoned  by  the 
amount  of  "radium  element"  for  each  square  centimeter; 
the  proportion  of  a-,  ft-,  and  7-radiation  depending  upon 
the  filters. 

On  account  of  the  difficulty  of  procuring  these  radio- 
active salts,  it  is  desirable  to  give  them  the  greatest  amount 
of  protection  from  harm  or  loss  through  careless  handling. 
The  most  common  forms  of  applicators  are  small  metal 
tubes  which  contain  the  radio-active  salt,  or  encase  a  small 
glass  tube  .or  bottle  in  which  this  salt  is  placed.  It  must 
be  remembered  if  they  are  sealed  within  a  glass  container 
as  they  age,  gases  are  given  off  and  explosions  have  resulted; 
therefore  in  handling  old  sealed  tubes,  the  greatest  care 
must  be  taken  to  guard  against  this  accident. 

When  transferring  these  small  glass  containers  from  one 
metal  case  to  another,  or  when  opening  any  applicator 
containing  these  radio-active  salts,  it  should  be  done  over 
and  close  to  a  glazed  sheet  of  paper;  for  should  any  accident 
occur  the  contents  would  drop  upon  the  glazed  paper, 
which  could  be  promptly  folded  and  the  salt  collected  with 
little  loss. 

The  metal  container  may  be  made  of  aluminium,  silver, 
platinum,  gold,  or  even  lead,  depending  largely  upon  the 
amount  of  filtration  desired;  and  if  some  very  slight  resisting 
metal  is  employed,  like  aluminium,  then  the  /3-rays  can  be 
used,  but  where  they  are  not  desirable  they  can  be  filtered  by 
an  additional  encasement  of  sufficient  metal  to  obtain  the 
desired  result.  These  metal  containers  have  been  given  the 


VARNISH  APPLICATORS 


127 


name  of  radiodes  by  the  late  Dr.  Shober;  although  the  word 
seems  to  apply  most  aptly,  there  is  very  little  tendency  toward 
its  adoption  for  general  use.  Radiodes  are  made  so  they 
may  be  tied  together  either  in  the  form  of  a  chain  or  else 
arranged  side  by  side,  forming  a  square;  this  adaptation  to 
different  forms  gives  them  a  wide  range  of  usefulness,  for 
the  application  to  irregular  parts. 

FIG.  35 


Shober's  radiode. 


For  the  maturation  of  the  apparatus  sufficient  time  must 
be  allowed  for  the  radio-active  salt  that  is  employed  to 
regain  the  activity  lost  in  the  transfer,  where  it  has  been 
found  necessary  to  dissolve  it  and  allow  it  to  recrys- 
tallize;  the  time  required  for  this  process,  varies  with  the 
salt  used.  Radium  salts  usually  require  a  month,  meso- 
thorium  a  somewhat  longer  time  to  regain  their  full  activity. 
The  cause  of  this  period  is  the  removal  of  the  "active 
products  and  the  emanation"  which  require  a  certain  time 


128          PHYSICAL  PROPERTIES  OF  APPARATUS 

to  re-accumulate.  During  this  time  of  maturation  the  color 
of  the  crystal  changes,  becoming  darker  with  age,  and 
if  a  varnish  is  used  to  fix  the  salt,  it  changes  from  its 
natural  yellow  to  a  deep  brown  color.  After  the  applicator 
has  matured,  if  radium  salts  are  employed,  they  remain 
constant  with  very  little  variation. 

For  the  sake  of  cleanliness,  where  these  applicators  are  to 
be  used  upon  a  series  of  cases,  covers  of  various  kinds  are 
useful;  several  layers  of  sterile  gauze  will  prove  sufficient 
where  the  surfaces  are  dry;  but  where  moisture  exists  or 
where  the  applicator  is  to  be  placed  in  a  cavity,  thin  sheet 
rubber  should  be  used;  under  some  circumstances  tubes 
made  of  celluloid  or  glass  must  be  employed. 

Filters  or  Screens. — In  the  great  majority  of  instances 
that  come  under  treatment  the  low  rays  are  not  desirable. 
In  order  to  eliminate  them  certain  metals  and  other  ma- 
terials are  placed  about  the  applicator  to  cut  them  off,  and 
these  articles  have  been  named  filters  or  screens. 

They  may  consist  of  air,  cotton,  rubber  tissue,  leather, 
mica,  aluminium,  copper,  silver,  tin,  lead,  gold,  or  platinum, 
according  to  the  requirments  of  the  condition  to  be  treated. 
If  air  is  to  be  used  as  a  filter,  the  radio-active  salt  is  placed 
at  a  given  distance  from  the  surface  of  the  body.  The 
low  rays  are  eliminated  in  proportion  to  the  distance,  but 
it  must  not  be  forgotten  that  the  high  rays  also  lose  in 
value.  Under  this  procedure  the  further  the  radio-active 
salt  is  from  the  object  the  fewer  high  rays  impinge  upon 
it;  therefore  quite  a  different  effect  is  obtained  by  direct 
filtration.  The  a-particles  are  completely  eliminated  by  a 
thin  sheet  of  metal  or  even  several  layers  of  ordinary 
paper;  they  are,  therefore,  only  to  be  considered  in  naked 
specimens  of  these  salts;  some  few  perhaps  escape  from 


FILTERS  OR  SCREENS 


129 


applicators  where  the  salts  are  mounted  in  varnish,  but 
a  few  inches  of  air  is  all  that  is  required  to  completely 
annihilate  them.  With  the  /3-rays  it  is  somewhat  different; 
and  while  a  piece  of  sheet  lead  a  few  millimeters  thick  will 
cut  off  many  of  the  low  rays,  it  is  doubtful  whether  they 


Showing  the  difference  in  proportion  of  the  a-,  /3-,  and  }'-rays,  with  and 
without  filter.  By  increasing  the  thickness  of  the  filter  the  proportion  of 
the  gamma-rays  becomes  greater,  the  alpha-rays  are  finally  cut  off,  and  the 
softer  beta-rays  next,  until  the  filter  is  increased  to  1  cm.  of  lead,  where 
all  the  /3-rays  are  practically  cut  off.  There  are,  however,  other  secondary 
j8-rays  formed  along  the  path  of  the  gamma  rays.  (Diagrammatic  sketch 
modified  from  Razet.) 

are  all  eliminated  by  even  a  piece  of  sheet  lead  1  cm. 
thick.  There  is  some  confusion  upon  this  point,  which 
results  from  the  formation  of  secondary  j8-rays  along  the 
path  of  the  gamma-ray.  The  diagram  of  Razet,  somewhat 
modified,  illustrates  this  change  in  the  different  rays  and 
takes  into  consideration  the  formation  of  these  secondary 
9 


130 


PHYSICAL  PROPERTIES  OF  APPARATUS 


rays  along  the  path  of  the  other  rays.  The  knowledge 
of  the  formation  of  the  secondary  rays  along  the  path 
of  these  high  rays,  especially  when  they  meet  with  some 
obstruction,  such  as  a  filter,  is  of  vital  importance  for 
the  protection  of  the  surrounding  tissue  from  the  low 

FIG.  38 


y  ray 

Few  ft  possible 
all  secondary 


fleavy  filter 


filter 


Showing  the  different  proportions  a-,  ft-,  and  y-rays,  with  and  without 
filters,  and  the  secondary  formation  of  /3-rays. 

secondary  rays  formed  about  the  material  used  especially 
to  occlude  them.  The  formation  of  these  secondary  rays 
differs  considerably  in  different  metals;  some  seem  much 
more  irritating  than  others,  but  in  a  general  sense  the 
denser  the  metal  filter,  the  greater  the  formation  of  these 
secondary  rays.  To  eliminate  them  it  is  necessary  to  have 


RADIABILITY  OF  FILTERS 


131 


these  filters  in  turn  filtered  by  some  less  dense  material, 
such  as  paper,  cotton,  rubber,  tissue,  or  even  air.  This  is 
demonstrated  somewhat  diagrammatically  in  the  illustration 
showing  the  elimination  of  some  of  the  low  rays  but  the 
formation  of  others  above  the  filter. 


FIG.  39 


III 


Diagram  showing  the  absorption  of  the  a-  and  0-ray  by  aluminium. 

The  name  of  "cashe"  has  been  given  by  M.  Sagnac  to 
a  small  lead  cone,  covered  with  several  layers  of  paper, 
then  with  rubber,  and  the  window  at  the  bottom  covered 
with  mica.  The  radio-active  salt  can  be  held  in  the  apex 
of  the  cone,  filters  placed  where  desired,  and  then  the  cashe 


132         PHYSICAL  PROPERTIES  OF  APPARATUS 

applied  where  the  radiation  is  necessary,  the  lead  acting  as 
a  filter  for  the  objectionable  rays,  and  the  paper,  rubber, 
and  mica  finally  cutting  out  practically  all  the  secondary 
radiation,  leaving  only  those  rays  desirable  for  the  thera- 
peutic effect  that  may  be  required. 

Radiability  of  Filters. — The  metals  usually  employed  for 
the  filtration  of  these  rays  are  aluminium,  silver,  and  lead. 
Gold  and  platinum  are  preferred  by  some,  the  contention 
being  that  the  secondary  radiation  from  them  is  not  so 
irritating  as  from  lead,  which  corresponds  to  them  in 
density.  The  amount  of  filtration  of  the  different  rays  is 
not  exactly  in  proportion  to  their  density,  as  might  be  sup- 
posed. There  is  a  slight  variation  for  the  different  varieties 
of  radiation;  for  the  gamma-ray,  for  instance,  in  the  case  of 
aluminium  is  14;  silver,  75;  and  lead,  122.  This  allows  a 
wide  variation  of  filtration  values  for  the  different  metals, 
and  likewise  this  filtration  is  not  directly  proportionate  to 
different  thicknesses  of  the  same  metal ;  therefore  when  care- 
ful study  is  to  be  made  of  the  amount  of  radiation  passing 
through  a  given  filter,  measurements  should  be  calculated 
directly  from  it  for  the  different  rays. 

Aluminium  screens  are  useful  when  it  is  desirable  to  filter 
out  only  the  very  low  ray.  The  lightness  of  the  metal 
and  its  ease  of  manipulation  as  a  thin  foil,  which  does  not 
fall  apart  and  retains  its  shape  without  crushing,  make  it 
especially  desirable.  These  filters  are  most  useful  in  dermal 
conditions,  such  as  acne,  capillary  nevi,  pruritus,  lupus, 
keratosis,  and  other  superficial  lesions;  the  thickness  may  be 
varied  from  0.01  mm.  to  2  mm.,  the  thinnest  filters  allow- 
ing many  of  the  alpha-particles  to  pass  through,  while  the 
thickest  cut  out  a  large  proportion  of  the  /3-rays. 

Silver  filters  cut  out  the  softer  radiation  better  than  the 


RADIABILITY  OF  FILTERS  133 

aluminium,  and  when  used  in  screens  of  0.5  mm.  to  1  mm. 
thickness  will  be  found  useful  in  the  treatment  of  skin 
affections  which  require  a  deeper  radiation.  It  has  the 
advantage  over  thin  lead-foil  in  that  it  holds  its  shape  when 
made  in  small  capsules  or  tubes,  and  therefore  can  be  more 
easily  cleansed. 

Lead  filters  are  used  for    deep    radiation   (Surpenetrant 
radiation  of  Wickham)  when  it  is  desirable  to  remove  all 

FIG.  40 


RANGE  OF  B  RAYS 


o      PRINCIPALLY  X  RAYS 


LUU 

90 
80 
70 
60 
50 
40 

so 

20 
10 

\ 

\ 

\ 

\ 

\ 

\ 

\ 

\ 

X 

\. 

-—•  — 

—  -  — 

-       •  . 

.01   .02    .03    .04    .05   M    .07    .08    .09     1. 

MILLIMETERS  OF  LEAD 


1.5 


Diagram  showing  the  penetration  of  the  /8-  and  y-radiation  through 
different  thicknesses  of  lead. 


soft  rays,  in  cases  of  tumors  which  are  deeply  embedded  in 
surrounding  tissues.  These  screens  vary  in  thickness  from 
0.1  mm.  to  3  or  4  mm.,  depending  largely  upon  the  strength 
of  the  salt.  On  account  of  the  soft  quality  of  the  metal, 
tubes  or  capsules  of  this  material  must  be  handled  with 
care,  otherwise  they  are  likely  to  be  crushed.  They  also 


134          PHYSICAL  PROPERTIES  OF  APPARATUS 

tarnish  rapidly,  which  under  some  circumstance  might  be 
objectionable.  These  lead  capsules  are  often  covered  by 
a  jacket  of  some  other  metal,  such  as  silver,  which  gives 
them  more  firmness  and  therefore  less  likelihood  of  injury. 
Platinum  as  a  substitute  for  lead  is  preferred  by  some,  as  it 
lacks  these  disadvantages;  the  initial  cost,  however,  must  be 
considered. 

The  practical  application  of  these  radio-active  salts  may 
be  separated  into  two  divisions:  (1)  the  superficial  conditions 
and  (2)  deep  conditions.  In  the  former  a  large  amount  of 
radiation  may  be  applied  for  a  short  time,  with  practically 
no  filtration.  On  the  other  hand,  where  a  deep  tumor  is 
to  be  treated,  heavy  filtration  is  needed  for  the  protection 
of  the  tissue  beneath  the  applicator.  To  some  extent  this 
can  be  accomplished  by  frequently  changing  the  site  of 
application  upon  the  surface,  yet  keeping  in  range  the  object 
upon  which  these  rays  are  to  be  centred. 

In  making  applications  to  superficial  conditions,  some 
authors  recommend  the  direct  application  of  the  radiode  to 
the  skin,  provided  the  surface  is  dry,  using  .only  some  anti- 
septic, .such  as  formalin,  to  sterilize  the  applicators.  While 
a  few  low  rays  may  be  sacrificed  by  the  interposition  of  some 
thin  rubber  tissue  or  oiled  silk,  or  even  thin  waxed  paper, 
which  may  be  destroyed  after  use,  it  would  seem  to  be  a  better 
method  and  the  results  in  the  end  would  be  practically 
the  same.  In  those  instances  where  the  surfaces  are  moist, 
these  articles  are  necessary  to  protect  the  radiode. 

The  surface  to  be  treated  must  be  carefully  cleansed,  all 
dried  crusts  should  be  removed,  and  after  cleansing  should 
be  well  dried,  as  moisture,  either  from  secretions  or  from 
the  application  hinders,  to  some  extent,  the  penetration  of 
the  low  rays.  Ointments  and  dusting  powders,  especially 


CROSS-FIRE 


135 


those  containing  a  heavy  base,  must  be  limited;  and  applica- 
tions should  not  be  made  previous  to  the  time  of  radiation 
which  would  interfere  with  the  proper  cleansing  of  the  part. 


FIG.  41 


"Cross-fire;"  R,  the  radium  mounted  upon  a  cone  of  lead  covered  with 
gauze;  T,  the  tumor;  the  area  a,  b,  c,  d  receives  the  full  amount  of  radiation 
while  a',  b',  c',  d',  d'  and  the  area  between  the  radium  received  only  a  partial 
radiation  .  The  remaining  portions,  n,  are  entirely  protected. 

Cross-fire. — This  frequent  change  of  position,  or  having 
several  applicators  at  different  points  at  the  same  time, 
has  been  termed  "cross-fire"  by  Wickham,  of  Paris.  The 


136          PHYSICAL  PROPERTIES  OF  APPARATUS 

word  is  most  significant  and  the  actual  bombardment  of 
of  these  rays  is  focussed  upon  one  spot,  deep  within,  and 
yet  the  surface  tissues  receive  a  rather  insignificant  amount 
of  radiation.  The  areas  over  which  the  applicators  have 
been  employed  should  be  marked  by  a  pencil  of  methylene 
blue  or  nitrate  of  silver,  so  that  at  the  next  application  the 
former  site  can  be  easily  recognized  and  avoided.  By  this 
method  of  frequent  changing  of  the  site  of  application  and 
proper  filtration  it  is  often  practicable  to  give  a  large 
amount  of  deep  radiation  without  the  least  disturbance  of 
the  superficial  or  overlying  structures. 

When  the  object  of  radiation  is  below  the  surface,  the  prepa- 
ration of  the  apparatus  is  somewhat  different  and  must  be 
modified  according  to  the  requirements  of  the  individual 
case;  they  are,  however,  much  the  same  in  their  general 
principles.  The  first  consideration  is  the  possible  injury 
of  the  intervening  structures.  One  method  to  avoid  this 
accident  is  by  frequently  changing  the  site  of  application 
"cross-fire;"  and  with  this,  proper  filtration  of  the  radio- 
active salt,  eliminating  all  the  low  rays.  With  this  in  view, 
the  applicator  is  covered  with  silver,  lead,  platinum,  or  gold, 
the  thickness  varying  from  0.1  mm.  (if  the  object  is  directly 
below  the  surface)  to  2  or  3  mm.  if  it  should  be  very  deep. 
This  metal  should  be  covered  with  2  cm.  to  5  cm.  of 
gauze  or  cotton,  to  eliminate  the  secondary  radiation  from 
the  metal;  over  this,  a  layer  of  oiled  silk,  waxed  paper,  OF 
rubber  tissue,  depending  somewhat  upon  the  position  in 
which  the  apparatus  is  to  be  placed  and  the  character  of  the 
surface,  whether  it  is  dry,  moist,  or  discharging  freely. 
After  the  preparation,  the  apparatus  may  then  be  fixed  to 
the  part  desired  by  adhesive  plaster,  a  bandage,  or  where  the 
application  is  of  short  duration  it  may  be  held  by  the  hand, 


CROSS-FIRE  137 

providing  the  proper  protection   is  given,  such   as  a  long 
handle,  well  shielded. 

For  the  radiation  of  ulcers  and  masses  in  cavities  the  prepa- 
ration is  somewhat  similar  to  the  former  except  that  allowance 
must  be  made  for  the  better  protection  of  the  applicator. 
For  this  purpose,  celluloid  or  glass  tubes  that  can  be  properly 
sealed  may  be  employed  where  the  radiation  of  surface 
conditions  alone  is  desired.  Where  there  is  a  mass  deeply 

FIG.  42 


'l^^fcffH^-/- 

Vr.e-j.s  *r\,9Jtrlt  •• 


A  transverse  section  of  an  applicator  inserted  into  a  cavity:  m,  the 
tumor;  st,  the  surrounding  tissue;  r,  the  radium  surrounded  by  filter  (/), 
which  is  partly  covered  to  protect  the  tissue  by  the  heavy  filter  (hf) .  Over 
this  are  placed  several  layers  of  gauze  to  remove  the  secondary  radiation; 
and  a  celluloid  tube  (ci)  to  protect  against  (fir)  moisture. 

embedded  in  the  tissue,  lead  or  platinum  capsules  that  can 
be  sealed  may  be  employed  to  advantage.  A  point  that 
must  be  taken  into  consideration  where  the  radium  is  to  be 
used  in  cavities  is  the  direction  and  site  to  be  treated.  It  must 
be  remembered  that  these  radio-active  salts  give  off  their 
rays  in  all  directions  equally  and  in  the  same  ratio;  there- 
fore the  protection  of  the  surrounding  tissues  under  these 
circumstances  is  a  matter  for  serious  consideration. 


138          PHYSICAL  PROPERTIES  OF  APPARATUS 

While  it  is  possible  to  interpose  screens  which  will  to  some 
extent  hinder  the  radiation  where  it  is  not  desired,  it  cannot 
be  entirely  eliminated.  For  this  purpose  a  screen  of  lead  3 
or  4  mm.  thick,  with  a  window  cut  corresponding  in  size  to  the 
site  of  radiation,  will  aid  to  some  extent  by  allowing  a  greater 
amount  of  these  rays  to  reach  the  place  where  they  are 
desired,  while  the  surrounding  tissues  receive  a  minimum 
amount.  The  preparation  of  the  apparatus  for  a  cavity  is  as 
follows:  Where  the  radiation  is  only  desired  upon  the  sur- 
face, a  radium  tube  surrounded  by  a  very  thin  filter  (which 
can  be  omitted  if  the  cavity  is  simply  ulcerated)  is  employed. 
Where  a  mass  exists  in  the  tissue,  a  filter  of  heavy  metal 
1  or  2  mm.  thick  is  used.  Over  this  is  placed  the  "guard," 
with  a  window  cut  out  to  allow  a  certain  area  to  receive 
most  of  the  radiation;  this  is  surrounded  by  several  layers 
of  gauze  or  paper,  and  the  whole  is  protected  by  a  celluloid 
capsule  that  may  be  properly  sealed. 

If  the  cavity  is  large  enough  to  permit  the  use  of  tampons, 
the  surrounding  tissues  may  be  protected  to  a  greater 
extent  by  placing  the  apparatus  as  described,  directly 
over  the  site  of  disease,  and  back  of  it  as  much  cotton  or 
wool  as  the  space  will  permit,  in  this  way  bringing  the  sur- 
face where  radiation  is  not  desired  as  far  away  as  possible. 
The  valuable  point  always  to  be  remembered  is  that  spaces 
invariably  give  the  best  filtration. 

Before  the  apparatus  is  introduced  the  cavity  should 
be  properly  cleansed  and  rendered  as  dry  as  possible.  Where 
tenderness  exists,  local  anesthetics  may  be  employed,  but 
this  will  be  found  to  be  rarely  necessary,  as  it  is  always  more 
or  less  possible  to  accommodate  these  applicators  to  any 
size  and  position  of  the  cavities,  and  if  they  are  made  so 
that  they  can  be  introduced  without  stretching  or  changing 


CROSS-FIRE  139 

the  position  of  the  parts,  very  little  pain  will  result.  As 
most  of  these  cavities  discharge  freely  when  irritated,  they 
should  be  subjected  to  the  least  amount  of  disturbance, 
since  the  discharge  coming  between  the  applicator  and  the 
diseased  area  interferes  with  the  operation  by  hindering  the 
radiation  with  the  mass.  There  is  also  a  likelihood  that 
the  position  of  the  apparatus  may  be  disturbed  from  the 
same  cause. 

It  is  particularly  difficult  to  make  proper  applications  to 
the  cavity  of  the  mouth,  due  to  reflexes  exciting  muscular 
contractions  which  cause  the  flow  of  mucus  and  saliva.  If 
the  single  treatment  is  to  be  extended  over  one,  two,  or 
more  hours'  duration  it  may  be  necessary  to  remove  the 
applicator  at  frequent  intervals  to  rest  the  excited  muscles 
and  cleanse  the  cavity.  Under  these  circumstances  anchors 
or  guides  must  be  so  placed  upon  the  applicator  as  to  bring 
it  into  exactly  the  same  position  as  before  removal. 

The  other  natural  cavities,  such  as  the  vagina,  rectum, 
external  auditory  canal,  etc.,  do  rfot,  as  a  rule,  show  this 
irritability.  Even  when  the  applicators  are  introduced  high 
into  the  rectum  or  into  the  stomach  through  the  esophagus, 
when  once  they  are  brought  into  position,  they  rarely  excite 
reflexes  sufficient  to  cause  trouble. 

Applicators  containing  radio-active  salts  should  under  no 
circumstances  be  placed  in  cavities  without  being  firmly 
fixed  by  a  rod  or  strong  cord  by  which  they  may  be  easily 
removed;  without  such  guide  there  may  be  some  difficulty 
in  finding  them,  and  disastrous  results  may  follow  a  too 
long  and  undesired  radiation. 

Implantation. — When  the  radio-active  salt  is  to  be  im- 
planted in  a  tumor,  the  preparation  is  somewhat  different 
from  the  preceding.  The  applicator  must  be  as  small  as 


140          PHYSICAL  PROPERTIES  OF  APPARATUS 

possible.  The  capsule  which  acts  as  a  filter  should  be  made 
of  silver,  and  have  a  small  ring  at  one  end  for  the  purpose 
of  tying  a  strong  silk  cord  to  it. 

The  site  of  operation  is  prepared  as  usual,  and  an  opening 
is  made  directly  into  the  centre  of  the  mass.  After  all 
bleeding  has  been  checked  the  capsule  is  wrapped  in  several 
layers  of  gauze  and  packed  firmly  into  the  bottom  of  the 
opening.  This  gauze  soon  becomes  moist  from  the  serum  and 
blood  and  in  this  way  acts  as  a  filter  for  the  secondary 
radiation. 

While  implantation  was  formerly  practised  to  a  greater 
extent  than  at  present,  it  usually  resulted  in  failure,  from  the 
fact  that  the  activity  of  the  salt  was  not  sufficient  to  produce 
the  result.  However,  this  operation  is  rarely  necessary, 
for  by  the  proper  filtration  and  "cross-fire"  method  it  is 
possible  to  reach  a  tumor  at  any  depth,  and  do  far  less 
harm  by  the  rays  passing  through  the  tissues,  than  the 
irritation  and  chance  of  infection  caused  by  an  open  wound. 

There  is  a  most  decided  contrast  between  the  action  of 
these  elements  in  the  two  methods.  Where  it  is  implanted  in 
the  middle  of  a  tumor  the  action  near  the  applicator  is 
intense,  while  the  vital  portion  of  the  tumor,  the  periphery, 
receives  only  a  mild  degree  of  radiation;  therefore  the 
degeneration  in  the  centre  is  intense,  while  the  edges  are 
possibly  only  mildly  irritated,  and  under  some  conditions 
may  be  even  stimulated.  In  contrast  to  this  where  the 
"cross-fire"  method  is  employed,  all  portions  of  the  tumor 
receive  an  equal  amount  of  radiation  and  consequently  the 
degeneration  is  equal. 

Wax  or  paraffine  has  been  employed  as  a  means  of  intro- 
ducing these  radio-active  salts  into  the  tissues  where  degen- 
eration is  desired.  One  of  the  insoluble  salts  of  radium  is 


THE  EMANATION  OF  RADIUM  141 

incorporated  in  the  wax  or  paraffirie,  which  is  injected  into 
the  tumor  in  a  liquid  state.  It  rarely  produces  any  degree 
of  infection  and  after  the  tumor  has  subsided  most  of  the 
wax  can  be  recovered,  with  the  salts,  that  are  not  soluble, 
but  remain  like  the  paraffine,  unabsorbed. 

Where  there  is  not  a  sufficient  quantity  of  these  radio- 
active salts,  to  have  a  number  of  assorted  applicators, 
the  most  practical  form  for  a  single  one  is  to  have  the  salts 
contained  within  a  small  glass  tube,  which  is  encased  within 
another  made  of  aluminium.  In  this  way  the  material 
is  protected,  with  very  little  of  the  low  radiation  being  lost. 
The  aluminium  container  can  then  be  encased  in  lead,  where 
low  radiation  is  not  desired.  With  proper  manipulation  and 
care,  practically  all  the  therapeutic  values  can  be  obtained, 
but  not  with  the  same  ease  and  comfort  as  where  applica- 
tors are  made  to  suit  the  condition. 

The  emanation  of  radium  is  at  times  more  convenient  for 
practical  use  than  the  salts  of  that  element,  and  where 
it  is  employed,  the  shape  of  the  applicator  may  be  modified 
according  to  the  requirments  of  the  individual  case.  The 
emanation,  being  a  gas,  requires  the  primary  containers  to 
be  sealed  and  they  therefore  must  be  made  of  some  material 
that  it  is  possible  to  seal.  After  the  gas  has  been  intro- 
duced, a  thin  glass  tube  or  one  made  of  lead  answers  the 
purpose  admirably,  as  both  lead  and  glass  are  worked 
with  ease  by  one  having  some  mechanical  skill.  It  must 
be  remembered  that  this  gas  undergoes  a  rapid  degeneration, 
and  where  it  is  used  allowance  must  be  made  for  it.  The 
degeneration  is  uniform  and  if  the  age  and  strength  are 
known,  calculation  at  any  time  is  not  a  difficult  problem. 

These  emanation  tubes  are  valuable  where,  for  some 
reason,  it  is  not  desirable  to  risk  the  radium,  from  which  it 


142  PHYSICAL  PROPERTIES  OF  APPARATUS 

is  obtained.  They  cannot,  however,  be  shipped  any  great 
distance,  as  the  loss  in  strength  is  extremely  rapid,  especially 
in  the  first  few  days. 

Where  the  low  radiation  is  desirable  it  is  possible  to  use 
the  emanation  in  the  form  of  a  compress,  mixed  with  some 
inert  powders,  or  as  an  ointment.  This  method  has  had 
very  limited  use,  and  care  must  be  taken,  when  the  appli- 
cation is  made  directly  to  the  surface  of  the  body,  that  the 
emanation  is  not  too  strong.  The  same  caution  should  be 
observed  in  the  employment  of  these  preparations  from  the 
emanation  as  would  be  used  with  radium;  the  activity  of 
radium  depends  upon  the  emanation  and  the  emanation 
upon  the  "active  product."  Therefore,  should  the  emana- 
tion come  in  contact  with  the  surface  of  the  body  it  could 
not  be  removed  and  a  burn  would  result,  the  severity 
depending  upon  the  strength  and  age  of  the  emanation. 

Under  proper  manipulation  these  applicators  for  the 
emanation  may  be  varied  in  strength,  either  by  first  charg- 
ing them  with  the  required  amount  and  then  making  use 
of  them,  or,  if  they  are  overcharged,  by  waiting  a  certain 
length  of  time,  until  the  decay  of  the  product  reaches  the 
strength  desired. 

While  the  use  of  the  emanation  in  some  form  has 
many  points  in  its  favor,  it  must  be  remembered  that 
the  preparation  requires  a  large  amount  of  radium  with,  at 
the  same  time,  more  or  less  technical  skill  on  the  part  of 
the  operator  in  the  manipulation  of  the  process,  and  that 
every  tube  must  be  measured  for  the  amount  of  radiation  it 
possesses. 


PART  II. 
PHYSIOLOGY  AND  THERAPEUTICS. 


CHAPTER  IX. 
PHYSIOLOGICAL  ACTION. 

Effects  Observed  from  Local  Radiation — Reaction — Burns — Relief  from 
Pain  —  Selective  Action  —  Stimulation,  its  Significance  —  Effects  upon 
Bacteria  —  Systemic  Disturbances  from  Local  Applications  —  Internal 
Administration  of  Soluble  and  Insoluble  Salts — -Effects  of  Physiological 
Doses  upon  the  Heart — Alterative,  Stimulant  and  Diuretic  Action — 
Comparison  of  a-,  /3-,  and  }'-rays  with  x-rays — Influence  of  these  Rays 
upon  x-ray  Burns. 

THE  physiological  action  of  these  radio-active  elements 
must  be  considered  from  two  general  sources,  the  first 
being  when  applied  locally.  This  head  is  then  subdivided 
into  the  purely  local  effect  and  the  general  constitutional 
symptoms  therefrom  produced.  Secondly,  the  action  upon 
the  whole  system  and  the  local  effect  upon  the  different 
organs  when  these  radio-active  elements  are  administered 
internally  as  a  general  medicine. 

Therefore  it  will  be  considered  under  the  following  heads : 

A.  Local  application: 

1.  Local  effect. 

2.  Systemic  disturbance  resulting  from  local  appli- 
cation. 

B.  Internal  administration: 

1.  General  systemic  effect. 

2.  Local  effect  upon  different  organs. 


144  PHYSIOLOGICAL  ACTION 

Effects  of  Local  Applications. — When  these  radio-active 
elements  are  used  locally,  there  results  a  disturbance  of 
the  tissue,  which  is  made  more  manifest  the  longer  they 
are  applied.  This  effect  may  be  so  transient  that  upon 
casual  observation  no  change  is  evident  in  the  tissues, 
while  the  subjective  symptoms  may  be  only  a  slight  itching. 
If,  however,  the  application  is  prolonged  it  promotes  what 
has  been  called  a  reaction,  and  should  it  be  continued  this 
reaction  may  become  a  burn,  simulating  for  the  most  part 
the  same  characteristics  produced  by  the  Roentgen  ray; 
with  the  essential  difference,  that  no  burns  of  a  severe 
character  have  been  reported,  due  no  doubt  to  the  fact  that 
radium  has  been,  as  a  rule,  in  more  skilful  hands.  At  the 
same  time  the  action  from  radium  is  somewhat  different; 
the  radiation  comparing  with  the  medium  ar-rays  is  almost 
entirely  wanting  in  radium  or  thorium. 

The  local  action  depends  upon  bombardment  of  the  tissue 
by  the  projection  of  a  mixture  of  the  a  (alpha),  ft  (beta),  and 
7  (gamma)  rays  from  these  radio-active  elements.  The 
low  rays  are,  like  the  low  Roentgen  rays,  most  irritating 
and  produce  reaction  quicker  than  the  high  rays;  for  this 
reason  most  of  these  radio-active  salts  are  applied  in  some 
container  which  filters  off  these  low  rays  to  a  very  great 
degree. 

Even  in  applicators  made  with  varnish,  the  thin  layer 
of  resins  obstructs  all  but  about  1  or  2  per  cent,  of  these 
a-rays,  and  to  some  degree  the  low  /3-rays  also.  There- 
fore, while  a  number  of  low  rays  are  still  present,  and  will 
produce  a  decided  reaction,  it  is  as  a  rule  superficial.  Where 
these  low  rays  are  filtered  to  a  greater  extent  and  only 
higher  rays  are  allowed  to  escape,  the  reaction  will  be  deeper, 
and  should  a  burn  result,  it  is  decidedly  of  more  serious 


REACTION  145 

local  consequence,  and  would  possibly  produce  considerable 
systemic  disturbance. 

Reaction. — The  word  reaction  has  been  generally  adopted 
to  mean  that  local  effect  from  these  elements  which  is 
manifested  by  some  sign  or  symptom,  either  objective  or 
subjective.  It  usually  appears  at  a  varying  length  of  time 
after  exposure,  from  almost  the  time  of  application  to 
several  weeks;  its  duration  varies  and  eventually  subsides, 
leaving  either  no  trace  at  all  or  a  darkly  colored  pigmented 
spot  which  may  remain  for  years  and  then  gradually  dis- 
appear. The  behavior  of  these  local  manifestations  depends 
largely  upon  the  idiosyncrasies  of  the  individual.  There 
is  some  reason  for  believing  that  blondes  respond  or  react 
sooner  and  with  a  greater  degree  than  brunettes,  and  while 
this  is  a  general  rule,  it  has  some  exceptions.  Usually 
persons  having  a  skin  which  reacts  quickly  to  the  sun  are 
sensitive  also  to  these  radio-active  elements. 

The  individual  sensation  from  a  local  reaction  varies; 
many  complain  of  a  peculiar  numbness,  while  others  of 
burning,  itching,  and  even  pain;  and,  incongruous  as  it  may 
seem,  the  burning  and  itching  of  a  pruritus  and  the  pain  of 
a  neuralgia  are  relieved  by  treatment. 

The  excessive  reaction  has  been  termed  a  burn;  however, 
the  line  by  which  reaction  and  burns  are  separated  is  not 
sharply  drawn,  and  these  borderline  instances  may  be  con- 
sidered from  either  stand-point.  The  stage  of  reddening  may 
be  followed  by  vesication  and  this  by  ulceration;  either  one 
of  the  first  two  stages  may  be  extremely  short  and  pass 
unnoticed,  while  in  more  severe  cases  redness  may  be 
followed  by  a  slough,  the  depth  of  which  depends  upon 
the  dosage.  The  course  of  these  burns,  like  those  produced 
by  Roentgen  rays,  is  by  no  means  regular;  it  may  begin 
10 


146  PHYSIOLOGICAL  ACTION 

abruptly  and  advance  to  a  certain  stage,  to  be  followed 
by  rapid  recovery;  or  it  may  simply  remain  in  a  quiescent 
stage,  refusing  to  yield  to  any  form  of  treatment.  Recurrent 
ulcerations,  developing  at  times  after  the  healing  of  such 
radium  burns,  have  not  been  reported,  but  they  no  doubt 
follow  the  same  general  tendencies  as  those  produced  by  the 
Roentgen  rays.  Upon  healing,  the  skin  over  the  site  of  an 
ulceration  is  usually  left  puckered  and  pigmented.  The 
pigmentation  usually  disappears  in  a  short  time,  but  it 
leaves  the  telangiectatic  effect  that  is  so  noticeable  in  the 
burns  of  the  Roentgen  rays.  While  pigmentation  following 
the  healing  of  these  burns  from  radiation  is  to  be  expected, 
this  condition  usually  disappears  in  the  white  race,  but 
in  the  colored  race  the  opposite  conditions  prevail,  the 
absence  of  pigment  produced  by  these  burns  is  perma- 
nent in  the  colored.  This  is  not  pleasing  to  the  eye  in 
contrast  to  the  dark  skin;  the  spots  having  a  peculiar, 
blanched,  pink-white  color  of  scars.  Under  ordinary  radia- 
tion the  skin  darkens  in  the  colored  race  in  proportion 
to  the  amount  received,  but  should  ulceration  occur  in  this 
radiated  area,  absorption  of  pigment  is  very  likely  to 
follow. 

The  cause  of  this  local  disturbance  in  the  cells  of  the 
affected  part  is  by  no  means  clear,  but  the  ordinary  process 
of  inflammation  and  repair  is  observed,  varying  only  in 
degree  according  to  the  proportion  of  radiation.  The  ques- 
tion is  often  asked,  "Why  do  new  growths  disappear  from 
effects  of  radiation?"  and,  "Why  does  it  not  have  an  equal 
effect  upon  the  surrounding  tissues?"  A  very  rational 
answer  would  be  to  point  out  the  difference  between  tissue 
in  normal  condition  and  where  some  pathological  process 
exists.  In  sound  tissue  the  blood  supply  and  nerve  supply, 


SELECTIVE  ACTION  147 

particularly  the  combination,  the  vasomotor  supply,  are 
perfect;  the  giving  of  sustenance  to  each  cell  and  carrying 
off  the  effete  matter  is  accomplished  with  clock-like  pre- 
cision; while  in  the  tumor  mass  we  have  an  erratic  lot  of 
cells  each  striving  for  its  own  existence,  with  general  nerve 
or  blood  supply  to  aid  resistance;  the  healthy  tissue  of  the 
body  might  be  compared  to  a  well-organized  city,  where 
approved  systems  control  the  supply  and  demand,  while  the 
diseased  portion  resembles  a  mob. 

Selective  Action. — This  difference  of  action  upon  these 
tissues,  normal  and  abnormal,  has  been  described  by  some 
authors  as  a  peculiar  influence  possessed  by  these  radio- 
active substances  upon  certain  tissues  and  spoken  of  as  a 
selective  action.  It  must  be  admitted  that  there  is  some 
difference  in  this  local  action  upon  the  cellular  element  of 
the  same  individual.  However,  it  can  be  explained;  in 
most  instances,  surfaces  covered  with  a  moist  discharge, 
natural  or  unnatural,  will  endure  more  radiation  than  a 
dry  surface;  the  moisture  acting  as  a  filter  protects  the 
tissue  lying  beneath.  Parts  of  the  body  which  have  a 
rapid  and  free  supply  of  blood  withstand  radiation  to  a 
greater  degree  than  ordinary  tissue. 

It  is  a  well-known  fact  that  the  more  highly  organized 
epithelial  cells  are  much  more  susceptible  to  radiation  than 
those  of  the  ordinary  type,  and  that  all  epithelial  tissue  is  far 
more  susceptible  than  fibrous  tissue;  but  this  fact  is  observed 
in  other  forms  of  degeneration  as  well  as  degeneration  due 
to  radiation,  and  while  we  may  agree  that  the  different  forms 
of  tissue  accept  radiation  with  a  widely  different  result, 
it  can  hardly  be  due  to  any  selective  power  of  these  rays 
upon  the  cell ;  on  the  contrary,  it  would  seem  to  be  the  resist- 
ance of  the  individual  cell  against  the  power  or  force  of  these 


148  PHYSIOLOGICAL  ACTION 

rays  upon  them  as  individuals.  The  hair-forming  cells 
are  quite  susceptible  to  radiation  and  will  often  be  destroyed 
temporarily  without  the  slightest  sign  of  reaction  upon  the 
surrounding  skin.  The  deep  layers  of  cells  forming  the 
finger  nails  are  also  among  the  highly  susceptible  cells,  and 
persons  working  about  these  radio-active  elements,  handling 
them,  are  liable  to  have  pain  and  tenderness  resulting  from 
frequent,  short  exposures. 

There  has  been  considerable  microscopic  study  made  of 
tissue  subjected  to  the  radio-active  influence,  but  there 
seems  to  be  nothing  exceptional  that  could  be  ascribed 
alone  to  radiation.  The  form  of  degeneration  in  all  these 
cells,  whether  the  radiation  be  severe  or  mild,  is  identical 
with  processes  from  other  causes.  This  same  conclusion 
has  also  been  brought  out  by  experiments  upon  animals. 
In  mild  degenerations  the  atrophy  of  the  cells  is  very  slow 
and  the  local  changes  microscopically  may  be  very  hard  to 
demonstrate;  while  in  an  active  process  the  inflammatpry 
disturbances  and  the  cell  degeneration  are  well  shown 
histologically. 

Stimulation. — While  the  local  action  of  these  radio-active 
elements  upon  the  tissues  might  be  stated  to  be  inhibitory, 
proved  by  experiments  upon  fertile  eggs  and  fish  roe,  there, 
no  doubt,  exists  a  stage  when  this  local  action  is  purely 
stimulative.  Clinically,  under  some  conditions  it  might  be 
of  value,  while  in  other  instances  it  is  to  be  regarded  with 
some  degree  of  apprehension.  This  same  stage  of  stimula- 
tion has  also  been  noticed  when  mild  and  short  applications 
of  the  Roentgen  rays  have  been  made  to  tissue;  but  a  few 
mild  applications  have  caused  the  growth  of  hair,  as  in 
alopecia  areata,  or  where  these  short  applications  have 
given  rise  to  the  formation  of  warts  and  keratosis.  While 


STIMULATION  149 

there  seems  to  be  less  liability  of  the  stimulation  from  these 
radio-active  salts  producing  the  same  degree  of  growth  as 
the  Roentgen  rays  there  is  not  the  least  reason  to  doubt 
that  under  similar  conditions  the  same  result  might  be 
expected.  From  an  experimental  stand-point,  at  least,  the 
two  forms  of  radiation  produce  the  same  results,  for  where 
seeds  have  been  exposed  to  either  form  of  radiation  a  certain 
degree  seemed  to  produce  stimulation  of  growth,  while  if 
pushed  still  further  it  was  followed  by  inhibition.  Dr.  Abbe 
has  demonstrated  these  facts  in  a  rather  unusual  manner, 
where  he  has  experimented  with  the  effect  of  radium  upon 
plant  life,  and  alludes  to  it  as  follows: 

"The  stimulation  of  growth  depends  on  the  time  exposure, 
the  distance,  and  the  kind  of  rays  used.  I  believe  we  may 
assume  the  biological  acts  of  living  cells  to  be  the  same, 
whether  animal  or  vegetable. 

"In  these  experiments  I  used  oats  for  the  first  time,  be- 
cause of  their  rapid  growth.  In  four  weeks  an  oat  may  grow 
about  one  foot  high.  One  hundred  milligrams  of  pure  radium 
bromide  in  fine  glass  tubes  was  placed  in  a  bottle  with  two 
tablespoonfuls  of  selected  oats.  To  prevent  inequality 
of  action  the  bottle  was  strapped  to  the  axis  of  a  diminu- 
tive water  wheel  rigged  up  to  run  by  a  faucet  at  an  even 
revolution,  so  that  every  oat  was  in  turn  brought  in  contact 
with  the  radium  thousands  of  times  during  the  two  days' 
exposure.  At  certain  intervals  I  removed  twenty-five  oats 
and  labelled  them.  At  the  end  of  two  days  I  planted  them 
in  rows  in  special,  sifted  soil,  and  raised  them  first  under 
glass.  Beside  them,  under  similar  conditions,  a  rowT  of 
unradiumized  oats.  The  result  at  the  end  of  four  weeks  is 
shown  in  this  photograph.  The  plants  were  cut  at  the 
roots,  tied  in  bundles,  measured,  and  weighed.  Compared 


150 


PHYSIOLOGICAL  ACTION 
FIG.  43 


Normal         2  8         16         24         36         40 

RESULTS  OF  EXPOSUBE  TO  RADIUM. 


Time  exposed 

No 
radium 

Stimulated. 

Depressed. 

2  hours 
radium 

8 
hours 

16 
hours 

24            36            40 
hours      hours      hours 

Height    .      . 
Weight    .      . 

100 
100 

111 
111 

107 
120 

111 
116 

84            71            53 
48            44            32 

STIMULATION 


151 


to  the  normal  growth,  three  bundles  were  above  the  normal, 
and  three  below,  both  in  height  and  weight."    (See  Fig.  43.) 


FIG.  44 


Twenty  shelves  of  mosquito  netting,  each  holding  25  oats;  at  the  top  is  a 
plaque  of  5  milligrams  of  naked  radium. 


The  interpretation  of  this  experiment  is  this :  A  deterrent 
effect  on  cell  growth  depends  on  time  exposure,  and  must 
be  a  definite  equation  for  every  specimen  of  radium.  The 
main  value  lies  in  the  demonstration  that,  on  seeds  as  well 
as  tumors,  the  electrons  may  produce  detrimental  results, 


152  PHYSIOLOGICAL  ACTION 

as  well  as  mysteriously  beneficial  ones,  and  that  probably 
all  the  beautiful  effects  so  often  seen  result,  in  a  measure, 


FIG.  45 


Growth  of  oats  exposed  to  naked  radium  at  distances  from  \  to  4  inches. 
Twenty  rows.  Two  rows  for  comparison,  without  radium.  Exposed  six 
days.  Growth  after  planting,  one  month.  Nearest  two  rows  killed.  Fourth, 
fifth,  sixth,  seventh,  stimulated.  Beyond  seventh  (\\  inches)  all  retarded. 
The  nineteenth  most  stunted  of  all. 


No  radium 


1-U  inch 


2  inch 


3  inch 


Row 
Weight 
Grains 

N      N    i   1|  2 

3 

4 

5 

6    7 

8    9 

1011 

12 

13  14 

lf> 

16  17  18  19  20 

74      95      0    0 

14-708777796361 

49  62  58 

5059 

63 

6064624564 

Killed        Stimulated 


Stunted 


STIMULATION  153 

from  accidentally  correct  time  exposure.  It  is  evident  that 
the  oats  were  alternately  near  and  far  from  the  radium  tube, 
as  they  whirled  about,  so  that  twenty-four  hours  of  exposure 
in  the  bottle  would  only  represent  a  part  of  an  hour  of  close 
contact,  such  as  takes  place  when  radium  tubes  are  applied 
on  tumors. 

A  second  experiment  was,  therefore,  necessary  to  show 
the  persistent  action  of  radium  at  a  fixed  distance. 

This  was  made  as  follows  (Fig.  44) :  A  series  of  twenty 
little  shelves  of  mosquito  netting,  one-fifth  of  an  inch  apart, 
was  arranged  by  cutting  a  square  hole  in  the  centre  of  thin 
boards  laid  on  top  of  each  other  with  netting  sandwiched 
between.  On  each  shelf  were  placed  twenty-five  oats,  and 
a  Wickham  plaque  of  naked  radium  (25  mg.)  was  bound  on 
top  of  all,  so  that  each  shelfful  received  a  given  bombard- 
ment of  radium  at  a  uniform  distance  during  a  similar  period. 
In  this  experiment  I  was  also  able  to  test  the  efficiency  of  all 
the  combined  rays  emitted  from  naked  radium  compared 
with  former  work  where  the  alpha-rays  were  suppressed  by 
the  glass  container.  The  exposure  of  these  seeds  was  con- 
tinued for  six  days,  with  frequent  shaking  to  change  the 
exposure  of  all  the  oats  on  each  shelf.  The  mosquito  netting 
would  offer  no  barrier  to  the  alpha-rays,  which  even  tissue 
paper  would  have  suppressed.  This  series  was  planted  in 
twenty  rows  an  inch  apart,  with  two  additional  rows  of 
unradiumized  oats  for  comparison. 

The  results  were  more  interesting  than  I  had  anticipated. 
The  two  rows  nearest  the  naked  radium,  but  not  in  contact, 
were  one-fifth  and  two-fifths  of  an  inch  from  it.  They  all 
germinated  and  tried  to  sprout,  but  died  before  they  were 
an  eighth  of  an  inch  high,  during  the  first  week. 

Those  in  the  third   row  were  up  2  inches;   the  fourth 


154  PHYSIOLOGICAL  ACTION 

row,  3|  inches;  the  seventh  to  the  eleventh  rows  were  out- 
doing all  but  the  normal  ones,  which  were  5  inches.  At 
the  end  of  four  weeks  the  fourth,  fifth,  sixth,  and  seventh 
rows — which  had  been  f  to  1  inch  from  the  radium — were 
now  the  finest  of  all,  even  exceeding  the  unradiumized  rows, 
notably  of  a  rich  growth,  darker  green  in  color,  and  12| 
inches  high.  All  plants  were  now  cut  at  the  roots,  tied, 
photographed,  measured,  and  weighed  (Fig.  45). 

Let  us  first  remember  that  the  seeds  had  been  continuously 
played  on  for  six  days  by  a  discharge  of  all  the  electrons 
issuing  from  the  naked  radium.  Let  us  recall  that  alpha- 
rays  are  known  to  be  of  slight  penetrating  power,  of  short 
area  of  travel,  and  subject  to  change  into  other  rays. 

The  beta-rays  have  relatively  feeble  penetrating  power, 
and  carry  charges  of  negative  electricity.  The  physics 
of  these  rays  is  credited  with  soft  and  hard  qualities,  the 
former  of  feeble  penetration,  the  latter  going  deeper  into 
the  tissues.  The  gamma-rays,  swift,  ultrapenetrating,  of 
negative  electric  charge,  are  probably  the  ones  more  efficient 
in  all  use  of  radium  in  glass  or  metal  containers. 

The  interpretation  of  the  experiment  on  oats  at  fixed 
distances  from  the  radium  shows  that  the  nearby  cells, 
up  to  half  an  inch  distant,  were  all  killed.  These  had  the 
combined  rays,  but,  above  all,  were  exposed  to  the  alpha. 

The  seeds  at  distances  from  \  inch  to  1^  inches  were 
greatly  stimulated  beyond  normal  growth.  These  had  the 
combined  beta-  and  gamma-rays,  as  well  as  any  secondary 
ones  emanating  from  the  decay  of  the  short  alpha-rays. 

The  seeds  from  1^  to  4  inches  were  depressed  in  their 
growth,  but  singularly  enough  not  in  inverse  ratio  to  their 
distance,  as  would  be  the  case  were  the  energy  a  losing  one 
as  the  distance  grew  greater,  or  as  it  might  be  considered 


STIMULATION  155 

if  it  had  lost  by  absorption  in  nearby  seeds.  On  the  con- 
trary, the  more  distant  seeds  were  most  affected,  so  that  at 
from  1^  to  4  inches  the  growth  represented  by  size,  weight, 
and  color  of  the  plant  showed  most  injury  at  the  farthest 
end;  the  weakest  plants  being  on  the  nineteenth  row,  or 
about  4  inches  away.  One  may  interpret  this  phenomenon 
as  he  wishes,  but  as  I  had  elaborately  thought  out  the  experi- 
ment to  secure  fair  play  for  each  seed  in  choice,  planting, 
soil,  moisture,  nurture,  sunshine,  etc.,  I  must  attribute 
the  inequality  of  growth  to  only  one  cause — radium. 

I  am  inclined  to  ascribe  an  irritating  and  stimulating 
quality  to  the  alpha  and  soft  beta-rays,  and  a  destructive 
force  to  the  deep,  penetrating,  hard  beta-  and  gamma-rays. 

The  twenty  shelves  of  oats  should  represent  twenty 
corresponding  sections  of  a  tumor  subjected  to  the  same 
experiment. 

Therefore,  while  this  stage  is  purely  transient,  it  must  not 
be  forgotten  that  a  result  may  be  produced  quite  contrary 
to  the  one  desired. 

The  beneficial  effects  of  radiation  in  certain  diseases  has 
been  thought  to  be  due  to  the  effect  upon  bacteria,  and  from 
an  experimental  stand-point  this  view  has  some  substantia- 
tion, for  the  same  effect  is  noticed  with  the  lower  order  of 
plant  life,  such  as  the  molds  and  bacteria,  as  has  been  so 
well  illustrated  by  the  experiments  upon  seeds.  While  many 
lists  have  been  published  showing  its  influence  upon  the 
various  fungi,  there  is,  however,  considerable  difference 
between  experiments  due  doubtless  to  surroundings,  which 
to  a  great  extent  affect  the  growth  of  these  different  varieties. 

From  these  experiments  it  would  be  difficult  to  make 
a  deduction  as  to  what  actually  occurs  within  the  tissues 
of  the  body,  and  it  is  not  improbable  that,  while  this 


156 


PHYSIOLOGICAL  ACTION 


effect  upon  these  germs  might  be  fatal,  if  the  tissues  receive 
the  same  amount  of  radiation  they  would  suffer  likewise; 
therefore  this  theory  cannot  be  accepted  in  its  entirety. 

ACTION  OF  RADIUM  UPON  BACTERIA. 


10  mg.  RaBr1 
30  to  40  mm. 

Prodigiosus. 

Staphylc- 
coccus. 

Strepto- 
coccus. 

Trichophyton 
tonsurans. 

Achorion. 
Schoenleinii. 

6  hours                     living 

living 

living 

living             poor  growth 

12  hours 

living 

living 

poor  growth     poor  growth       poor  growth 

18  hours 

living 

living 

poor  growth            dead              poor  growth 

24  hours 

dead 

poor  growth 

dead                    dead              poor  growth 

36  hours 

poor  growth 

dead              poor  growth 

48  hours 

dead 

dead 

General  Systemic  Disturbances  Resulting  from  Local  Applica- 
tions.— The  general  symptoms  resulting  from  these  local 
disturbances  depend  to  some  degree  upon  the  locality  that 
has  been  radiated,  and  the  extent  of  radiation.  A  certain 
amount  of  radiation  upon  the  thigh  might  produce  an 
inflammatory  disturbance;  if  given  under  the  same  circum- 
stances upon  the  head,  might  cause  a  meningitis,  either 
from  direct  inflammation  or  secondarily  from  degeneration 
of  surrounding  tissue,  forming  an  abscess  and  possibly 
sepsis. 

Where  a  large  tumor  has  been  radiated  it  may  undergo  a 
gradual  dissolution,  break  down  without  becoming  necrotic, 
and  cause  a  toxemia.  The  poisons  of  the  degenerated  mass 
are  introduced  into  the  system  in  a  proportionately  large, 
yet  regular  manner,  and  are  eliminated  through  the  regular 
channels;'  while  on  the  other  hand,  the  radiation  may  be 
pushed  to  such  an  extent  as  to  cause  a  necrosis  of  the  tumor 
tissue,  since  the  neighboring  cells  and  vessels  are  not  able  to 


DISTURBANCES  FROM  LOCAL  APPLICATIONS     157 

carry  off  the  debris  which  results  in  the  formation  of  an 
abscess.  The  symptoms  in  this  instance  are  not  those  of  a 
toxemia  but  a  septicemia.  In  either  case,  where  persons 
are  treated  for  large  masses,  and  the  system  is  debilitated, 
it  must  be  remembered  that  it  is  possible  to  overload  their 
resistance  with  these  products  of  decomposition,  which  must 
be  eliminated.  Where  the  place  of  reaction  is  upon  the 
surface  of  the  body,  with  the  formation  of  an  open  wound, 
the  same  conditions  exist  as  when  the  mass  is  buried  beneath 
the  surface,  but,  in  addition,  infection  is  much  more  likely 
to  occur  and  the  absorption  of  septic  products  follows. 
However,  if  free  drainage  can  be  established  from  the 
surface,  the  system  is  less  burdened  and  possibly  the 
general  toxic  effect  may  be  less. 

The  following  experiment  of  the  action  of  radium  upon 
globulins  is  interesting:  If  two  solutions  are  prepared  from 
ox  serum,  one  made  electro-positive  by  the  addition  of  acetic 
acid,  and  the  other  electro-negative  by  the  addition  of  am- 
monia, drops  of  the  latter  solution,  when  exposed  to  the 
rays  of  radium,  turn  rapidly  to  a  jelly  and  become  opaque, 
while  the  opalescence  of  the  former  is  rapidly  diminished, 
showing  complete  solution.  This  action  is  due  to  the 
a-radiation.  While  this  illustrates  the  effect  only  from  a  very 
non-penetrating  ray,  it  does  explain,  to  some  extent  at  least, 
the  liability  of  systemic  effects  due  alone  to  local  radiation. 

The  pain  in  these  processes,  whether  the  degeneration  be 
upon  or  below  the  surface,  varies  with  the  individual;  in 
some  instances  there  may  be  entire  absence  of  the  manifes- 
tation of  suffering,  while  in  others  the  pain  will  be  excru- 
ciating, the  general  effect  upon  the  person  being  a  matter 
of  individual  equation. 

In  regard  to  fever,  urinary  secretion,  and  other  concomi- 


158  PHYSIOLOGICAL  ACTION 

tant  symptoms,  the  process  of  degeneration  from  radiation 
does  not  differ  in  the  least  from  any  other  of  a  similar  nature. 

There  is,  however,  a  train  of  symptoms  which  occasion- 
ally follow  the  local  application  of  these  radio-active  elements 
which  at  present  cannot  be  explained  and  are  entirely  dis- 
proportionate to  the  amount  of  radiation.  They  may  be 
purely  psychical,  but  are  probably  due  to  the  elimination 
of  certain  toxins  from  the  area  of  local  exposure  that  cause 
more  or  less  irritation  to  the  general  system.  These  mild 
symptoms,  such  as  headache  accompanied  with  nausea, 
vertigo  lasting  often  for  several  days,  after  a  marked 
degree  of  irritability  and  sleeplessness,  are  often  accom- 
panied with  a  marked  gastro-intestinal  disturbance,  pain, 
diarrhea,  vomiting  and  at  times  the  cardiac  symptoms 
may  be  most  alarming.  In  some  few  instances  the  continued 
use  seems  to  have  some  influence  upon  metabolism  and 
causes  a  progressive  emaciation.  While  the  foregoing  symp- 
toms from  the  local  application  of  a  reasonable  amount  of 
radiation  are  by  no  means  common,  lassitude  and  a  desire 
to  sleep  are  quite  frequent;  these  conditions  are  often  most 
desired  and  possibly  may  be  at  times  explained  by  the  relief 
afforded  from  the  local  effect  of  the  radio-active  salt. 

The  local  effect  of  all  these  radio-active  elements  depends 
entirely  upon  the  amount  of  radiation  and  not  upon  the  ele- 
ment or  its  form.  The  radio-activity  from  the  emanation  acts 
in  the  same  way  as  an  equal  amount  of  salt  from  which  it  is 
derived,  provided  it  is  balanced  in  equilibrium  in  regard  to 
the  a,  /3,  and  7  variety  of  radiation.  There  has  been  an 
effort  to  prove  a  specific  action  for  the  a-,  /3-,  and  7-radiation 
upon  tissue,  but  it  appears  that  this  difference  is  merely  a 
matter  of  proportion  between  volume  and  penetration.  This, 
however,  differs  in  the  administration  of  these  radio-active 


INTERNAL  ADMINISTRATION  159 

elements  internally.  Under  these  circumstances,  not  only 
the  element  must  be  considered  but  also  the  time  it  remains 
within  the  body  and  its  method  of  elimination.  The  action 
from  the  soluble  and  insoluble  salts  of  radium  necessarily 
differs,  due  to  the  fact  that  the  soluble  salt  is  rapidly 
absorbed  and  rapidly  eliminated,  while  the  insoluble  salt 
may  stay  in  the  tissue  for  an  indefinite  period,  giving  off  by 
its  slow  disintegration  the  emanation  that  continues  in  very 
small  quantities  to  be  carried  through  the  system  so  long  as 
the  salt  remains. 

Internal  Administration. — The  soluble  salts  of  these  radio- 
active elements,  while  in  the  body,  give  off  the  same  amount 
of  radiation  from  their  products  of  disintegration,  but  only 
continue  in  that  proportion  wrhile  in  the  tissue  and,  neces- 
sarily being  soluble,  they  are  rapidly  eliminated  with  the 
secretions.  The  emanation  from  both  products,  being  a  gas, 
leaves  the  body  in  the  same  manner  as  other  gases,  but  only 
such  a  proportion  of  emanation  is  formed  from  these  products 
as  would  be  naturally  expected  under  their  disintegration 
process.  The  insoluble  salts  supply  to  the  tissues  of  the 
body  emanation  for  an  indefinite  period,  while  the  soluble 
salts  supply  the  same  amount  to  the  body  before  its  com- 
plete or  partial  elimination. 

These  radio-active  elements  may  be  classed  as  alteratives, 
and,  like  drugs  of  this  group,  are  used  in  diseases  where  the 
pathology  is  obscure.  Their  adoption  has  been  purely  upon 
empiricism,  in  such  instances  where  the  action  upon  the 
tissues  demands  a  decided  reconstruction.  The  adminis- 
tration of  any  considerable  amount  of  these  radio-active 
elements  may  be  accompanied  by  the  most  profound  changes, 
and  there  seem  to  be  few  organs  of  the  body  which  escape. 
Startling  changes  occur  in  the  blood  with  a  marked  alteration 


160  PHYSIOLOGICAL  ACTION 

in  the  pressure  which  in  the  weak  and  debilitated  are  likely 
to  cause  death. 

The  experiments  upon  animals  by  Smith1  illustrate  the 
manner  of  absorption  and  elimination  of  radium  salts  and 
emanation,  and  to  some  extent  act  as  a  guide  for  their 
medicinal  use.  His  conclusions  are: 

1.  That  after  the  administration  of  radium  by  mouth  or 
by  injections  a  widespread  degree  of  radio-activity  is  evident 
throughout  the  body. 

2.  That  elimination   of   radium   takes   place   principally 
and  rapidly  by  the  bowels,  in  a  minor  and  slower  degree  by 
the  kidneys,  while  in  mice,  at  all  events,  there  is  no  evidence 
that  the  liver  or  skin  plays  any  part  in  excretion.    As  regards 
the  elimination  of  the  element  by  the  bowels,  it  is  certainly 
excreted  by  the  small  intestines,  and  there  are  indications 
that  the  large  bowel  also  assists  in  that  function. 

3.  That  the  high  activity  in  the  lungs  is  possibly  due  to 
the  extreme  vascularity  of  these  organs,  but  its  constant 
presence  at  all  times  after  inoculation  and  the  fact  that  the 
emanation  is  entirely  eliminated  by  the  lungs  suggest  that 
an  accumulation  of  radium  takes  place  with  a  view  to  the 
more  ready  excretion  of  the  emanations. 

4.  That  the  emanation  can  be  obtained   in   solution  in 
various  media  and  can  be  introduced  into  the  body  in  small 
doses  by  inhalation,  feeding,  or  by  injection. 

5.  That  after  such  administration,  and  however  intro- 
duced, a  general  radio-activity  of  very  brief  duration  is 
caused  throughout  the  body. 

6.  The  elimination  of  the  emanation  takes  place  princi- 
pally, and  almost  entirely,  by  the  lungs,  and  to  a  very  slight 
extent  by  the  kidneys. 

1  Quart.  Jour,  of  Med.,  1912,  p.  249. 


INTERNAL  ADMINISTRATION  161 

7.  That  the  duration  of  the  activity  induced  in  the  body 
or,  in  other  words,  the  time  taken  by  excretion,  differs  with 
regard  to  the  nature  of  the  preparation  used.    Soluble  salts 
of  radium  are  rapidly  eliminated,   however  administered. 
The  insoluble  salts  per  os  are  excreted  directly  by  the  bowel, 
and  there  is  no  evidence  of  any  temporary  absorption  and 
circulation.    When  given  by  injection,  however,  an  exceed- 
ingly slow  elimination  takes  place  by  the  bowel.    The  time 
taken,  however,  is  so  great  that,  for  all  intents  and  purposes, 
the  salt  may  be  considered  to  be  permanently  present  at 
the  site  of  injection. 

8.  The  elimination  of  the  emanation  occurs  with  great 
rapidity,  and  is  complete  after  administration  in  powerful 
doses  in  so  short  a  time  as  four  hours. 

The  same  observations  have  been  made  in  regard  to 
thorium  and  actinium.  The  changes  are  more  or  less  pro- 
found, depending  entirely  upon  the  salt  or  preparation  and 
the  mode  of  administration.  Necessarily  the  most  profound 
effects  are  observed  from  the  uses  of  these  elements,  hypo- 
dermically  or  intravenously. 

The  effect  -upon  the  breathing  is  at  first  to  increase  it, 
both  in  volume  and  depth,  with  a  gradual  subsidence  to 
a  lowering  of  the  rhythm  and  depth,  and  from  larger 
amounts  an  asthmatic  condition  may  be  induced.  The 
blood-pressure  is  usually  lowered,  and  continues  for  some 
time  afterward,  depending  much  upon  the  elimination. 
Under  these  circumstances  the  action  upon  the  blood  is 
usually  very  slight;  however,  in  larger  doses  or  in  individuals 
who  are  easily  influenced  by  the  effects  of  these  elements, 
a  leukocytosis  may  be  produced  varying  in  proportion  with 
the  dosage.  The  normal  condition  is  rapidly  restored  after 
the  elimination  of  the  offending  element. 
11 


162  PHYSIOLOGICAL  ACTION 

In  physiological  doses  it  seems  to  have  very  little  effect 
upon  the  ferments  of  the  body,  such  as  the  saliva,  gastric, 
pancreatic  or  intestinal  juices,  all  of  which  show  considerable 
radio-activity  under  the  influences  of  the  different  radio- 
active elements,  nor  are  the  ferments  of  these  juices  affected 
when  removed  from  the  body  and  placed  beside  a  tube  of 
high  activity.  If  the  gland  or  glands  secreting  these  juices  are 
influenced  locally  by  radiation,  the  same  changes  are  noted 
as  would  be  observed  in  any  other  condition  of  inflam- 
mation. 

The  saturation  of  all  parts  of  the  body  is  well  illustrated 
by  the  radio-activity  of  the  child  in  a  pregnant  mother  given 
water  containing  emanation  of  radium  of  about  4000  m.  u. 
one-half  hour  before  birth,  and  a  subsequent  dose  of  4000  m.  u. 
five  minutes  before  birth.  Examination  of  the  blood  in  the 
navel  cord  showed  the  presence  of  the  emanation  of  50 
m.  u.  to  the  liter;  placenta  3  to  5  m.  u.;  meconium,  3  m.  u.; 
and  the  breast  milk,  one-half  hour  after,  21  m.  u.  per  liter. 

At  the  point  of  exit  from  the  body,  as  the  lungs,  the  kidneys, 
and  under  some  circumstances  where  insoluble  forms  of  these 
radio-active  elements  given  by  the  mouth  and  eliminated 
by  the  bowel,  are  noticed  the  greatest  changes;  particularly 
in  the  kidneys  where  the  emanation  is  employed,  the  urea 
is  increased  100  per  cent.,  therefore  the  emanation  may  be 
regarded  as  a  powerful  diuretic.  In  some  individuals  there 
is  a  decided  change  in  the  elimination  of  all  purin  products 
while  in  others  this  disturbance  is  scarcely  noticeable. 

The  effect  upon  the  geni  to-urinary  system  is  that  of 
stimulation,  if  given  in  moderate  doses,  internally  or  locally 
as  baths.  This  is  in  direct  contrast  to  the  effect  of  radiation 
from  the  x-ray,  and  no  doubt  7-radiation  from  these  elements, 
if  locally  applied,  would  not  have  the  same  effect.  However, 


•    COMPARISON  WITH  THE  ROENTGEN  RAYS      163 

the  systemic  use  of  these  radio-active  elements  cannot  be 
expected  to  agree  with  the  effects  of  local  applications. 

As  a  glandular  stimulant,  the  interest  manifested  in 
trying  to  connect  the  endemic  developments  of  goitre  with 
the  surrounding  water  supply  is  another  fact  pointing  to  the 
stimulating  properties  of  small  quantities  of  these  radio- 
active elements. 

Comparison  with  the  Roentgen  Rays. — Comparisons  are  often 
made  between  the  Roentgen  radiation  and  the  radiation 
from  these  radio-active  elements;  and  while  rays  of  equal 
penetration  seem  to  exist  in  both  forms  of  radiation,  from 
a  physical  point  of  view  they  do  differ,  and  reference  to 
this  has  been  made  in  the  physical  section.  The  rays  that 
penetrate  a  given  amount  of  tissue  to  a  certain  depth  differ 
widely  in  their  character.  For  instance,  a  middle  /3-ray 
might  be  compared  with  a  fairly  low  axray,  while  a  middle 
x-ray  compares  with  the  high  /3-ray,  and  if  there  is  such 
a  wide  difference  between  these  two  rays  of  equal  pene- 
tration from  a  physical  stand-point,  it  would  certainly  seem 
that  there  should  be  a  difference  between  their  action  upon 
the  tissue.  Generally  considered,  the  action  of  these  rays 
upon  tissue  might  be  said  to  be  similar,  excepting  their 
power  of  penetration.  Taking  the  a-,  /3-,  and  7-rays  as  a 
group,  comparison  can  easily  be  made  to  the  energy  given 
off  from  an  axray  tube.  Two  facts  must  be  taken  as-  a 
basis.  Low  rays  do  not  penetrate,  are  irritating,  and  carry 
with  them  an  amount  of  force  that  does  not  seem  to  exist 
in  the  high  rays,  which  are  penetrating  and  do  not  seem 
to  produce  so  much  irritation.  The  7-rays  of  radium  and 
mesothorium  are  decidedly  more  penetrating  than  the  anrays, 
consequently  it  can  be  expected  that  they  are  decidedly  less 
irritating,  which  does  seem  to  be  the  fact  from  observation. 


164  PHYSIOLOGICAL  ACTION 

Therefore  the  7-ray  penetrates  each  individual  cell,  produces 
a  general  reaction  of  all  the  cellular  elements,  and  all  parts 
degenerate  simultaneously;  the  force  of  the  low  ray  is 
expended  upon  the  cell  wall  and  the  nucleus  escapes, 
thereby  allowing  the  cell  to  regenerate. 

The  radiation  from  these  radio-active  salts  is  uniform  in 
regard  to  the  amount  and  the  constancy  of  penetration,  while 
under  the  best  management  possible  there  will  be  some  varia- 
tion in  the  degree  of  penetration  of  the  radiation  given  from 
the  x-ray  tube.  The  value  of  the  radiation  from  the  radio- 
active salts  can  be  measured  and  the  definite  amount  of 
dosage  can  be  determined;  while  on  the  other  hand  the 
dosage  of  radiation  from  the  axray  tube  is  a  variable  quantity. 

In  either  event  there  are  certain  tissues  that  seem  to  yield 
better  results  from  the  effects  of  these  radio-active  salts, 
which  seem  less  prone  to  be  irritating,  provided  the  low 
rays  have  been  eliminated;  while  contrariwise  there  are 
conditions  where  the  Roentgen  radiation  seems  to  be  more 
efficient.  It  is  not  unlikely  that  in  the  future  they  will  divide 
into  two  classes,  those  best  suited  for  radiation  from  these 
radio-active  elements,  and  those  for  the  Roentgen  rays.  The 
study  of  the  tissues  from  a  histological  stand-point  fails  to 
reveal  any  degeneration  that  would  be  distinctive  of  either 
form  of  radiation. 

One  noticeable  point  is  that  the  laboratory  workers  in 
and  about  radio-active  elements  have  not  suffered  in  the 
proportion  that  workers  of  the  same  class  have  in  the 
making  and  handling  of  .r-ray  apparatus.  Furthermore,  a 
number  of  instances  have  been  reported  where  the  effects 
of  x-rays,  such  as  the  keratosis  and  small  trophic-like  ulcers, 
have  been  successfully  treated  by  the  application  of  these 
radio-active  salts;  yet  while  physically  the  action  of  these 


COMPARISON  WITH   THE  ROENTGEN  RAYS       165 

forces  are  so  much  alike,  they  evidently  must  differ  to  a 
very  wide  degree.  Burns  and  the  other  untoward  effects 
noticed  upon  the  laboratory  worker  in  the  radio-active 
elements  heal  promptly  and  do  not  leave  the  long,  indolent, 
ulcerative  condition  so  common  in  the  analogous  condition 
from  the  Roentgen  rays.  These  facts  more  than  any  of  the 
others  show  the  relative  difference  between  the  two  forms  of 
radiation. 


CHAPTER  X. 

THERAPEUTIC  VALUE  OF  NATURAL  WATERS 
AND  MINERALS. 

Springs — Wells — Spas — Emanatoria — Baths — Drinking-water — Local 
Application — Mud— Their  Application — Uranium  Minerals. 

THE  infinitesimal  amount  of  radium  occurring  in  these 
waters  is  well  illustrated  by  the  analysis  of  the  King's  Well 
in  Bath,  England,  where  Sir  William  Ramsey  estimated 
that  1,000,000  liters  contain  1.73  mg.  of  radium.  This 
spring  may  be  regarded  as  a  representative  of  its  class,  and 
explains  why  these  springs  have  been  of  such  value  as 
health  resorts  for  centuries. 

The  difference  in  effect  of  these  waters  when  transported 
to  any  great  distance  and  used  as  they  come  from  the 
spring  is  explained  by  the  radio-activity  derived  from  the 
emanation  of  radium,  which  degenerates  rapidly.  Other 
waters  having  exactly  the  same  chemical  composition 
without  this  activity  fail  to  have  the  same  therapeutic 
properties. 

Wells  in  the  neighborhood  of  Joachimsthal,  Austria,  and 
the  surrounding  countries  of  Bohemia,  Saxony,  and  Bavaria, 
all  show  a  relatively  high  activity,  being  rated  as  giving 
between  33  to  49.5  Mache  units  per  liter.  It  has  been  said 
that  some  of  them  give  as  high  as  1200  Mache  units;  but  as 
this  unit  has  been  rather  loosely  used,  this  high  assignment 
of  activity  is  undoubtedly  a  miscalculation.  It  may  be 


167 

possible  to  concentrate  the  activity,  but  manipulation  of 
these  waters  usually  drives  off  the  radio-activity  which 
they  naturally  possess. 

Some  of  the  resorts  and  spas  in  Central  Europe  have 
been  equipped  with  well-developed  emanatoriums,  where, 
if  the  natural  waters  are  not  of  sufficient  strength,  they 
are  artificially  increased  in  their  radio-activity  by  suitable 
apparatus  used  to  collect  it  from  the  waters  and  recharge 
them  directly  from  solutions  of  radium.  Japan,  South 
America,  and  the  United  States  have  followed  the  example 
set  by  Germany  and  France,  and  are  developing  their  natural 
waters  wrhere  it  is  possible  to  obtain  springs  of  sufficient 
strength. 

These  waters  may  be  employed  locally  in  the  form  of  a 
bath,  or  where  the  occasion  demands,  some  material  may  be 
moistened  and  formed  into  compresses  or  packs.  Internally 
they  might  be  used  as  drinking-water,  and  under  some  cir- 
cumstances the  local  and  internal  use  may  be  combined, 
as  in  douches  and  rectal  injections.  With  suitable  equip- 
ment, where  radium  is  the  source  of  activity,  rooms  or 
small  cabinets  may  be  arranged  with  mechanical  devices  to 
blow  air  through  these  waters  and  cause  a  certain  amount 
of  the  emanation  of  radium  to  be  taken  up  with  the  air 
and  be  distributed  in  these  rooms  or  cabinets  where  patients 
can  breath  a  radio-active  air.  This  gives  an  additional 
source  from  which  a  patient  can  derive  the  benefit  of  these 
waters. 

Under  natural  conditions  springs  with  the  highest  radio- 
active values  are  found  in  the  neighborhood  of  uranium- 
or  thorium-bearing  minerals;  there  are,  however,  exceptions 
to  this;  but  as  the  natural  resources  of  the  surrounding 
country  are  not  always  definitely  known,  the  failure  to 


168 


NATURAL   WATERS  AND  MINERALS 


detect  any  of  these  radio-active  minerals  in  the  soil  of  that 
locality  must  be  due  rather  to  the  lack  of  sufficient  analysis. 


RADIO-ACTIVITY  OF  SOME  OF  THE  NATURAL  WATERS 
OF  EUROPE. 


Joachimsthal  (iron  spring) 
Gastein,  Grabenbiickes  well 
Gastein,  Elizabeth's  well 
Gastein,  Chorinsky 
Baden-Baden  (salt)  (Butt) 
Baden-Baden  (salt),  Murquelle 
Landeck,  Georgenquelle  (sulphur) 
Landeck,  Freduchquelle  (sulphur)    .      .      . 
•  Landeck,  other  springs     ...... 

Karlsbad      .......... 

Karlsbad,  Muhlbrannem  (alkaline)         .      . 
Karlsbad,  Vordere  Schlaskbrunnen  (alkaline) 
Mergentheim  (alkaline) 
Marienbad  (alkaline)1        ...... 

Wiesbaden1  .....      ..... 

Homburg1     ........      ... 

Kissingen1     .......... 

Nauheim1      .......... 

Johannisbad  (temperature,  29°  C.)1        .      . 
Leplitz  (temperature,  21.9  to  32.5°  C.)1     . 
Villach  (temperature,  29°  C.)1      .... 

Kudowa  (iron)          .  .  .... 

Leukerbad  (arsenic,  calcium,  hot) 

Talheim  (sulphur) 

Neundorf 

Franzensbad  (mud)      ....... 

Wiesbaden   .......... 

Pistyan  Hungary  (hot,  temperature,  58°  C.) 
Porto  d'Ischia  (temperature,  65°  C.)      .       . 
Ragaz-Pfaffers,  Switzerland  (temperature,  41 
Naples   ..........  .      . 

Lacco  Ameno  (Ischia)  (temperature,  57°  C.) 

Castellamare 

Battaglia,  near  Padua  (temperature  72°  C.) 

Griesbach    . 


1  .  7  to 
0.4  to 


0.66  to 
0.8  to 
2.3  to 

2.  85  to 
0.29  to 
0.24  to 

3.  13  to 
0.8    to 
2.0 


2.8 
0.8 


600  .  0  m 
155.0 
133.0 
121.0 
126.0 
24.0 
206.0 
119.8 
53  .  8 
31.  51 
31.5 
17.4 
7.1 
4.57 
11.95 
8.0 
4.3 
28.6 
4.04 
6.56 
2.0 
to  22.5 

0.26 
16.3 
20.0 
16.0 
11.95 


to 

to 

1.32  to  203.0 
.       .  4.7 

°  C.)  0.33 

0.2    to      2.7 
36.9  to  372.0 
22.6 

2.5    to      4.6 
3.3    to    26.0 


When  these  waters  are  used  for  baths,  the  person  must 
be  fully  immersed,  having  as  little  of  the  body  above  the 
level  of  the  water  as  is  possible  for  breathing;  then  the 


1  Several  springs. 


169 

whole  tub  is  covered  with  a  rubber  blanket  and  the  water 
slightly  agitated;  the  patient  breathes  the  air  from  this 
water  charged  with  radio-active  gases,  thus  conveying  some 
of  the  activity  into  the  lungs.  These  radio-active  substances 
are  absorbed  by  the  lungs,  wrhich  play  a  very  active  part  in 
the  absorption  and  elimination.  The  time  given  for  each 
bath  varies,  as  a  rule,  from  fifteen  to  forty-five  minutes,  wrhile 
the  temperature  is  governed  to  suit  the  comfort  of  the  patient. 

The  water  employed  for  local  medication,  such  as  packs, 
compresses,  etc.,  is  usually  somewhat  stronger,  and  may  con- 
tain from  60,000  to  even  90,000  Mache  units  per  liter.  These 
strong  solutions  must  be  made  artificially,  as  the  natural 
waters  do  not  contain  this  high  activity. 

Radio-active  earth  and  mud  have  been  employed  in  the 
same  manner.  They  have  the  advantage  over  the  com- 
presses as  they  retain  the  moisture  longer,  and  possibly 
bring  the  radio-active  material  into  direct  contact  with 
the  tissues,  which  might  be  desirable  in  cases  of  rheumatism. 
In  those  instances  where  dermal  irritation  exists,  moisture  is 
usually  to  be  avoided. 

These  preparations  may  be  made  directly  from  the 
ground  powrders  mixed  with  water,  and  a  small  quantity  of 
glycerin  may  be  added  if  thought  desirable.  On  account 
of  the  expense,  where  these  earth  compresses  contain 
sufficient  radio-active  material,  they  may  be  sterilized  by 
heat,  and  re-applied,  provided  the  radio-active  material  is 
.  in  an  insoluble  form. 

Drinking-waters,  from  these  natural  sources,  are  usually 
of  about  the  same  activity  as  the  water  used  for  bathing 
purposes;  where  a  higher  activity  is  desired  it  is  necessary 
to  prepare  them  artificially  to  bring  their  strength  to  a 
sufficient  standard  to  be  of  medicinal  value. 


170  NATURAL  WATERS  AND  MINERALS 

Medicinal  Uses. — The  class  of  diseases  in  which  these 
waters  have  been  employed  and  recommended  are  those 
which  have  always  defied  the  best  efforts  of  the  medical 
profession;  their  pathology  is  not  understood  and  the  recom- 
mendation of  radio-activity  is  from  a  purely  empiric  stand- 
point. 

FIG.  46 


Fontactoscope.    Electroscope  for  estimating  the  radio-activity  of 
water  and  gases. 


According  to  Prof.  Ernst  Sommer,  of  Zurich,  these  waters 
have  been  found  of  value  in  the  following  diseases: 


MEDICINAL   USES  171 

1.  Anemia,  chlorosis,  and  allied  blood  diseases.     Those 
waters  having  iron  in  solution  will  be  of  value,  and  should 
be  taken  internally,  as  drinking-water. 

2.  Arteriosclerosis.     Water  having  sufficient  quantity  of 
emanation  to  lower  blood-pressure  should  be  used. 

3.  Bacterial  infections.     The  water  used  here  must  be 
of  sufficient  strength  to  have  a  bactericidal  action. 

4.  Arthritis;  subacute  chronic  and  deformans. 

5.  Infections  of  the  nose  and  adjoining  sinuses.    Water  is 
used  in  these  infections  as  a  douche. 

6.  Heart  affections;  myocarditis;  under  same  conditions 
as  No.  2. 

7.  Joint  disease  of  rheumatic  origin,  subacute  or  chronic. 

8.  Gout,  uric  acid  diathesis. 

9.  Skin  diseases   (eczema,   psoriasis).     Here  the  waters 
may  be  used  in  combination  with  stronger  radium  prepara- 
tions. 

10.  Chronic    exudative    conditions,    such    as    empyema, 
plastic  pleurisy,  perimetritis. 

11.  Sciatica. 

12.  Catarrhal  conditions  of  the  air  passages. 

13.  Diseases  of  the  lymphatic  system;  spleen;  enlarged 
glands  due  to  scrofula. 

14.  Chronic  diseases  of  the  bone. 

15.  Cancer  of  the  stomach.     Drinking  the  waters  gives 
considerable  relief  and  will  cause  patient  to  gain  weight. 

16.  Chronic  myocarditis. 

17.  Tumor. 

18.  Chronic  neuritis. 

19.  To   absorb   the   exudates   of   apoplexy   and   vicious 
bone  unions  and  operative  scars. 

20.  To  aid  in  building  up  the  tissues  in  convalescence. 


172  NATURAL  WATERS  AND  MINERALS 

21.  To  encourage  tissue  change  in  corpulency  or  diabetes. 

22.  Tabes  dorsalis;   will  relieve  the   condition   to   some 
extent. 

23.  Malignant  tumors  will  assist  other  means  in  restoring 
the  natural  condition. 

24.  Uterine  disease;  dysmenorrhea ;  para-  and  perimetritis. 
A  method  that  has  been  recommended  in  the  use  of 

these  waters  is  peculiar  and  apt  to  be  somewhat  tedious. 
The  patient  is  directed  to  sip  the  water  every  five  minutes 
for  two  hours;  then  a  rest  is  given,  and  another  sipping 
seance.  The  idea  seems  to  be  to  saturate  the  body  with 
these  charged  waters  slowly  and  evenly — in  other  words, 
saturating  the  body  and  keeping  it  in  that  condition,  which 
can  only  be  done  by  this  method.  The  emanation  which  is 
the  active  portion  of  these  waters  is  rapidly  eliminated 
by  the  lungs.  If,  therefore,  the  same  amount  of  water  is 
taken  at  one  time,  in  a  very  short  time  after  drinking 
most  of  the  activity  has  passed  out  in  the  expired  air,  and 
it  is  to  overcome  this  rapid  elimination  that  this  sipping 
method  of  taking  these  waters  has  been  recommended. 

Under  some  conditions  the  use  of  these  radio-active  waters 
and  muds  seems  to  be  contra-indicated,  such  as  acute  rheu- 
matism complicated  with  erythema  purpura;  or  acute  myo- 
or  endocarditis;  gout  in  the  acute  inflammatory  stage;  in 
tuberculous  disease  where  processes  are  active;  certain 
active  forms  of  acute  specific  arthritis,  and  conditions 
where  there  is  an  active  suppurative  process. 

A  factor  which  should  be  taken  into  consideration  in  the 
treatment  of  these  conditions  is  the  surroundings.  It  is 
well  known  that  the  results  obtained  in  sanatoria  and  spas 
are  most  satisfactory,  due  undoubtedly  to  the  rigid  routine 
adopted  in  these  institutions.  The  regularity  of  diet,  exer- 


CONCLUSIONS  173 

cise,  and  medical  treatment,  will  often  give  relief  to  condi- 
tions which  is  quite  impossible  to  obtain  at  home;  therefore, 
when  results  are  reported  from  these  institutions,  this  point 
must  be  taken  into  consideration. 

Where  these  waters  and  muds  are  to  be  employed  in  private 
practice,  their  strength  should  from  time  to  time  be  tested. 
In  fact,  some  preparations  upon  the  market  degenerate  in  a 
very  short  time,  and  only  show  the  faintest  signs  of  activity 
by  the  most  delicate  tests.  Far  more  active  preparations 
or  radio-active  muds  can  be  easily  made  by  simply  mixing 
small  quantities  of  commercial  uranium  oxide  or  the  various 
thorium  salts  with  a  sufficient  amount  of  kaolin  and  water 
to  dilute  the  activity. 

Reports  of  small  epitheliomas  and  of  lupus  vulgaris  suc- 
cessfully treated  by  the  local  application  of  the  natural 
crystals  of  autunite  have  been  made.  It  is  chemically 
composed  of  uranium  calcium  phosphate.  Applications  of 
several  hours'  duration  wrere  made  on  several  successive 
days  and  did  not  provoke  any  great  amount  of  reaction. 
Considering  that  under  these  circumstances  a  native  mineral 
was  used,  it  would  be  difficult  to  state  that  the  beneficial 
action  was  due  alone  to  the  uranium;  it  is  possible  that  it 
contained  the  usual  amount  of  radium,  thorium,  and  allied 
elements,  which,  as  a  rule,  are  associated  in  nature.  Reports, 
however,  have  been  made  where  uranium  salts,  artificially 
prepared,  have  been  used  under  similar  circumstances. 

Conclusions. — Accounts  of  good  results  from  the  use  of 
these  radio-active  waters,  muds,  and  earths  have  come 
from  many  sources,  and  seem  to  be  quite  satisfactory,  but 
it  must  be  remembered  that  the  diseases  for  which  we  find 
them  so  highly  recommended  belong  to  a  class,  which,  under 
certain  peculiar  conditions,  often  seem  to  undergo  a  most 


174  NATURAL  WATERS  AND  MINERALS 

beneficial  change  and  at  the  same  time  are  particularly 
prone  to  relapse  quite  as  unexpectedly.  It  might  be  well  to 
suspend  judgment  upon  the  real  value  of  these  radio-active 
substances  until  their  apparent  value  could  be  tested  under 
ordinary  circumstances. 


CHAPTER  XI. 
APPLICATION  IX  DERMATOLOGY. 

Principles  Involved  in  Treatment — Diseases  of  the  Hair — Keratosis — 
Eczema  —  Pruritus  —  Herpes  Zoster  —  Ichthyosis  —  Lichen  —  Psoriasis  — 
Xeroderma— Acne — Syphilis — Lupus. 

RADIUM  has  been  employed  as  a  local  therapeutic  agent  in 
dermatology  by  such  authorities  as  Wickham  and  Degras  of 
Paris,  Freund  of  Vienna,  Bayet,  Schiff,  and  many  others, 
who  have  reported  favorable  results.  The  indications  for  its 
use  are  particularly  those  instances  where  other  agents  have 
absolutely  failed,  or  where,  for  cosmetic  reasons,  other  agents 
are  liable  to  produce  scarring  and  disfigurement  of  the  sur- 
face of  the  skin,  either  from  the  application  of  the  medicant, 
or  from  contracture  of  the  scars  subsequent  to  or  in  conse- 
quence of  the  healing  of  the  lesion.  Under  such  conditions, 
where  the  disease  process  is  apt  to  produce  an  amount  of 
fibrous  tissue  giving  to  the  part  an  overgrowth  or  tumor- 
like  formation,  the  absorption  caused  by  the  application  of 
radium  or  thorium  products  causes  this  excess  of  fibrous 
tissue  to  be  absorbed,  leaving  the  tissues  in  a  condition 
more  or  less  resembling  the  normal  structures.  Under  cer- 
tain circumstances  it  may  be  like  many  other  therapeutic 
agents,  merely  a  matter  of  election,  being  desired  only  on 
account  of  its  ease  of  employment,  relieving  the  person 
affected  from  months  of  application  of  washes  and  oint- 
ments that  are  not  desirable  from  the  point  of  personal 


176  APPLICATION  IN  DERMATOLOGY 

comfort,  debarring  the  unsightliness  and  the  actual  discom- 
fort such  applications  usually  produce. 

These  radio-active  salts  must  be  used  with  the  greatest 
care  in  all  these  dermal  conditions,  and  should  only  be 
applied  by  one  familiar  with  the  various  diseases  of  the 
skin,  and  having  a  complete  knowledge  of  the  condition  and 
phases  of  the  various  eruptions;  likewise,  if  conversant 
with  dermatology  before  making  these  applications,  that 
person  must  have  a  thorough  knowledge  of  the  activity  of 
the  individual  form  of  application,  the  amount  of  radiation, 
and  the  length  of  time  to  be  applied;  otherwise  the  dosage 
will  not  be  in  conformity  with  the  process,  and  failure  will 
result  in  consequence. 

These  radio-active  salts  are  applied  in  these  conditions 
under  two  distinct  heads,  diametrically  opposed  to  each 
other,  yet  blending  so  closely  that  it  is  impossible  to  draw 
the  line  of  distinction. 

First,  they  are  applied  where  stimulation  is  desired.  Here 
the  dosage  is  extremely  small,  depending  upon  the  depth 
and  quality  of  the  tissue.  In  superficial  cases  the  radio- 
active salts  need  only  a  slight  filter.  If  the  varnish  appli- 
cator is  to  be  employed,  a  thin  sheet  of  mica,  aluminium,  or 
waxed  paper  may  be  used,  which  in  reality  is  more  for  the 
protection  of  the  radio-active  salts  than  a  filter.  Here  the 
a-,  |8-,  and  7-rays  act  together,  and  the  exposure  should  be 
extremely  short,  as  nearly  all  the  energy  of  the  radio-active 
salt  is  employed.  If  this  stimulation  is  desired  at  any 
given  depth,  thin  lead  filters  must  be  interposed  between  the 
applicator  and  affected  part,  the  time  of  application  made 
proportionately  longer,  also  calculation  for  the  loss  of 
energy  from  the  filter  and  the  penetration  of  the  tissues. 
Under  these  circumstances  the  /3-  and  7-rays  are  employed, 


APPLICATION  IN  DERMATOLOGY 


177 


the  a-rays,  which  are  the  most  dominant  source  of  energy, 
being  eliminated. 

FIG.  47 


Small    applicator   with   rubber    cover   for    protection.       Large   applicator 
surrounded  by  an  inch  and  a  half  of  gauze  to  cut  off  low  radiation. 

Where  it  is  desired  to  absorb  tissue  products,  the  appli- 
cation should  be  more  prolonged,  giving  rise  to  some  reac- 
tion which  secondarily  causes  absorption.  Again,  the 
depth  of  tissue  must  be  considered,  and  the  application  and 
applicator  arranged  accordingly.  As  a  general  rule,  a 
12 


178  APPLICATION  IN  DERMATOLOGY 

severe  reaction  is  never  desirable,  and  should  always  be 
avoided.  This,  however,  is  not  always  possible,  due  mainly 
to  the  idiosyncrasies  of  the  individual  under  treatment. 
Where  these  violent  forms  of  reaction  have  been  induced 
considerable  pigmentation  is  likely  to  follow,  which  often 
lasts  for  some  time  after  the  process  has  healed,  if  not  too 
severe,  it  eventually  disappears. 

The  action  of  these  rays  under  this  second  head  may  be 
termed  astringent,  and  if  carried  still  further,  pass  into  the 
atrophic.  This  gives  rise  to  a  dccongestive  stage  that  is 
desired  in  conditions  of  inflammation.  The  stage  between, 
which  might  be  termed  the  astringent  stage,  which  gives 
rise  to  the  decongestive  stage,  is  only  slightly  past  that 
of  stimulation;  while  the  atrophic  stage  is  a  large  one  and 
may  range  from  such  a  slight  degree,  which  really  might 
be  termed  astringent,  to  where  the  atrophic  condition  gives 
rise  to  an  actual  necrosis.  Just  how  much  radiation  is 
required  from  a  given  specimen  to  produce  these  results  is 
a  matter  of  experience,  and  still  more  actual  experience  with 
an  individual  application;  and  it  is  just  in  such  instances 
that  the  difference  between  radium  and  mesothorium  is  so 
manifest.  As  pointed  out  before,  the  constant  changing  of 
the  proportion  of  rays  in  mesothorium  must  give  a  different 
result  if  applied  in  the  same  manner  over  a  series  of  several 
years,  while,  on  the  other  hand,  radium  remains  constant, 
and  its  degree  does  not  change;  therefore,  when  one  becomes 
accustomed  to  handling  an  applicator  made  with  a  radium 
base,  it  would  seem  that  its  constancy  would  be  an  asset 
that  is  worth  considering.  This  fact  of  evenness  of  radiation 
is  more  important  in  dermatology  than  in  any  other  field, 
for  the  influences  desired  from  these  elements  require  the 
most  refined  technique  that  it  is  possible  to  develop. 


DISEASES  OF  THE  HAIR 


179 


Diseases  of  the  Hair. — In  most  instances  diseases  of  the 
hair  reported  in  literature  and  those  that  have  come  under 
observation  have  been  treated  by  the  Roentgen  rays.  This 
method  has,  as  a  rule,  been  found  most  satisfactory,  and 
no  doubt  the  reports  made  of  the  use  of  radio-active  salts 

FIG.  48 


Showing  the  depilatory  effects  of  radium.    Case  treated  for  a  gliorna. 

in  the  treatment  of  these  diseases  have  been  so  satisfactory 
that  a  change  in  the  form  of  treatment  is  not  desired.  This 
is  especially  marked  in  conditions  of  alopecia  areata,  where 
the  use  of  the  Roentgen  rays  has,  in  many  instances,  pro- 
duced the  desired  result  in  a  very  short  time. 


180  APPLICATION  IN  DERMATOLOGY 

In  the  treatment  of  alopecia  areata  only  very  mild  stimu- 
lating doses  should  be  used,  the  exposures  short  and  not 
too  frequent;  but  where  the  opposite  effect  is  desired, 
radiation  must  be  pushed  either  during  one  sitting  or 
several;  where  the  one-sitting  method  is  adopted,  a  most 
rigid  technique  is  required. 

Hypertrochosis. — Hypertrochosis  has  been  mentioned  as 
a  disease  that  could  be  benefited  by  radiation,  and  good 
results  have  been  reported;  but  as  the  depilatory  action  of 
the  milder  form  of  radiation  is  so  transient  it  is  hardly 
worth  the  risk  of  the  severe  reaction,  which  may  result  in 
a  scar,  or  in  a  local  condition  which  is  far  worse;  coarse, 
bristly  hairs  often  grow  and  become  extremely  troublesome 
from  their  irregular  growth,  therefore  radiation  in  any  form 
is  not  to  be  recommended.  Hypertrichosis  may  be  treated 
by  the  electric  needle,  and  where  it  is  skilfully  employed 
the  result  is  all  that  could  be  desired. 

Sycosis,  favus,  and  the  various  forms  of  tenia  trichophytin 
have  been  treated  by  radiation.  The  relief  in  these  diseases 
depends  upon  the  depilatory  effect  of  these  rays;  the  usual 
form  of  radiation  employed  for  these  infections  of  the  roots 
of  the  hair  was  the  Roentgen  rays;  it  appears  to  have  been 
most  satisfactory.  Many  reports  from  all  countries  show 
its  universal  use,  and  a  few  have  been  made  where  the  salts 
of  radium  or  thorium  have  been  used;  and  there  is  not  the 
least  reason  to  infer  that  they  would  not  have  been  equally 
efficient.  Wickham  and  Degras  refer  to  its  use  in  sycosis. 

Senile  keratosis  and  keratosis  occur  upon  the  face  or  back 
of  the  hands,  often  in  such  size  and  character  as  to  be  dis- 
figuring, at  times  producing  some  discomfort;  and  if  the 
irritation  that  has  caused  them  continues,  they  often  degen- 
erate and  become  epitheliomatous.  These  local  areas  usually 


ECZEMA  181 

yield  easily  to  radiation,  and  under  these  circumstances 
radium  or  mesothorium  is  to  be  desired. 

Symmetrical  palmar  keratosis  and  congenital  trophoneu- 
rotic  dyskeratosis,  allied  to  the  former  condition,  have 
been  treated  by  Wickham  with  radium  filtered  by  0.1  mm. 
of  aluminium. 

Angiokeratoma  in  a  female,  aged  twenty-one  years, 
was  treated  by  the  same  author,  and  was  successfully 
removed,  leaving  only  a  very  slight  scar  that  was  scarcely 
visible. 

Eczema. — Eczema  in  its  various  forms  has  been  treated 
by  these  radio-active  elements,  and  many  reports  have  been 
made  of  its  successful  use.  The  Bayet  series  of  99  cases  shows 
a  complete  healing  in  86  and  improvement  in  3.  The 
different  forms  reported  included  nearly  all  varieties.  The 
chronic  eczema  of  children  occurring  upon  the  face  and 
about  the  mouth  has  yielded  to  radiation  when  other 
forms  of  treatment  failed.  In  a  child,  aged  two  and 
a  half  years,  the  radium  was  applied  in  the  form  of  a 
flat  applicator  4  cm.  square,  wrhich  contained  160  mg.  of 
radium-barium  bromide,  filtered  through  rubber.  Two 
series  of  three  treatments  of  five  minutes  each  accomplished 
the  result.  Most  of  the  cases  of  this  class  wrere  treated  by 
this  technique.  Eczema  occurring  upon  the  palms  of  the 
hands  and  soles  of  the  feet,  with  deep  cracks  and  fissures, 
causing  considerable  discomfort  from  burning,  have  yielded 
to  the  applications  of  radium,  wrhich  must  be  powerful, 
and  the  sittings  very  short. 

Seborrheic  eczema  of  a  refractory  nature  that  has  not 
responded  to  milder  forms  of  treatment  and  other  cases 
as  non-pruriginous  eczema,  eczema  varicosum,  and  eczema 
licheno'ides  have  been  treated  with  radium. 


182  APPLICATION  IN  DERMATOLOGY 

Acute  eczema  has  been  successfully  treated,  and  under 
these  circumstances  these  radio-active  elements  must  be 
very  weak,  otherwise  the  irritation  caused  is  likely  to 
produce  considerable  discomfort.  The  applicators  used 
for  treatment  in  these  cases  should  be  large  and  flat,  so 
as  to  cover  considerable  surface;  usually  varnished  appli- 
cators without  screening  may  be  employed.  Wickham 
mentions  a  case  of  eczema  that  had  recurred  during  the 
summer  for  a  number  of  years;  numerous  applications 
were  tried  without  avail  until  treated  with  radium,  which 
resulted  in  complete  cessation  of  the  yearly  attack.  The 
same  author  calls  attention  to  the  following  points  in  the 
treatment  of  these  eczematous  conditions:  (1)  The  appa- 
ratus used  should  be  large,  with  powerful  radio-activity; 
(2)  make  short  exposures  with  intervals  between  them;  (3) 
use  weak  and  medium  rays,  without  filter,  or  only  a  very 
thin  one,  except  in  those  instances  where  deep  infiltration 
exists;  and  (4)  avoid  all  superadded  inflammation.  Atten- 
tion must  be  given  to  care  of  the  affected  parts,  and  the 
general  systemic  condition  in  the  same  manner,  as  is 
usual  in  other  forms  of  treatment  where  the  rays  have 
been  employed.  After  relief  of  this  local  condition,  it  is 
important  to  protect  the  patient  from  future  outbreaks, 
as,  for  instance,  if  the  eczema  is  due  to  some  irritant  from 
occupation  indigestion,  or  similar  cause,  it  must  be  corrected. 
The  success  in  the  treatment  of  these  cases  depends  to  some 
extent  upon  the  care  that  is  given  to  these  details  which  are 
so  often  disregarded.  It  must  be  remembered  also  that 
the  effect  of  radiation  is  purely  local  and  will  not  remove 
the  exciting  cause.  Neurodermatitis,  a  condition  often 
associated  with  some  of  the  different  forms  of  eczema, 
which  is  extremely  annoying,  causing  a  great  degree  of 


HERPES  ZOSTER  183 

discomfort,  is  likewise  easily  relieved,  when  treated  with 
these  radio-active  elements. 

Pruritus. — Pruritus  about  the  anus  and  scrotum  in  the 
male  and  vulva  in  the  female  is  at  times  intensely  annoy- 
ing on  account  of  the  intolerable  itching,  and  is  usually 
coexisting  with  some  systemic  derangement.  Where  the 
cause  cannot  be  corrected  by  internal  medication,  and  is 
dependent  upon  some  neurosis,  the  use  of  radiation  will 
be  of  value  for  local  relief,  and  this  in  time  wrill  act  advan- 
tageously upon  the  whole  system.  Either  the  radiation  of 
the  .r-rays  or  one  of  the  radio-active  elements  may  be  used. 
The  results  that  follow  cannot  be  accomplished  by  any 
other  method;  however,  if  the  local  condition  is  due  to 
some  direct  cause,  such  as  diabetes,  this  must  be  corrected, 
otherwise  radiation  will  not  be  found  practical. 

Treatment  in  these  cases  should  be  given  with  a  fair 
amount  of  filtration  (£  mm.  lead  screen),  as  penetration 
of  the  tissue  to  some  depth  is  desired.  The  result,  when 
accomplished,  seems  to  be  fairly  permanent. 

Wickham  anxd  Bayet  report  numerous  cases.  The  latter 
author  concludes  that  in  all  these  diseases,  depending  upon 
a  localized  dermal  neurosis:  (1)  Good  results  from  radium 
have  been  frequent;  (2)  they  heal  rapidly;  (3)  under  some 
conditions  where  recurrence  has  been  observed  the  attacks 
are  usually  milder  and  yield  easily  to  a  second  period  of 
radiation;  (4)  the  rapidity  and  thoroughness  with  which 
these  results  occur  is  remarkable,  especially  in  such  cases  as 
pruritus  of  the  arms,  vulva  or  scrotum,  conditions  which 
have  always  been  rebellious  under  the  best  treatment. 

Herpes  Zoster. — While  it  is  doubtful  if  the  course  of  the 
disease  is  to  any  extent  influenced  by  radiation,  the  local 
symptoms  can  be  relieved,  especially  in  those  cases  which 


184  APPLICATION  IN  DERMATOLOGY 

run  a  protracted  course;  the  influence  aiding  the  restora- 
tion of  the  local  parts  relieving  the  burning  pain  which 
causes  such  distress.  The  subsidence  of  these  symptoms 
gives  a  great  degree  of  comfort,  and  allows  the  withdrawal  of 
narcotics,  in  this  way  giving  rise  to  a  gain  in  strength  and 
general  systemic  improvement.  Good  results  have  been  re- 
ported from  both  forms  of  radiation,  and  at  the  present  time 
it  would  be  difficult  to  tell  exactly  which  is  most  desirable. 

In  other  painful  conditions  of  the  skin  dependent  upon 
some  local  neurosis,  radiation  will  be  found  to  be  of  value; 
it  must  be  carefully  applied,  and  fairly  well  filtered,  deep 
radiation  being  needed  to  reach  the  nerves  well  below 
the  superficial  layer  of  the  skin.  If  these  radio-active 
salts  are  to  be  used,  the  applicators  should  have  a  large 
surface  and  be  covered  with  high-test  salts.  Exposures 
should  not  be  long,  a  few  minutes  on  succeeding  days  for  a 
series  of  four  to  ten  days,  when  an  intermission  should  be 
given  of  a  few  days  to  several  weeks.  Usually  the  patient 
feels  a  decided  benefit  after  the  first  series  of  treatments, 
improving  with  each  successive  seance. 

Zosteriform  ichthyosis  has  been  successfully  treated  with 
radium  and  the  resultant  scar  was  scarcely  perceptible. 
This,  as  in  other  forms  of  diseases  of  the  same  character, 
needs  applications  with  a  fair  degree  of  penetration. 

Lichen  Ruber  Planus.  —  Lichen  ruber  planus  is  another 
disease  resulting  to  some  extent  from  a  debilitated  system, 
and  while  the  ultimate  relief  depends  to  some  extent  upon 
the  correction  of  the  existing  causes,  the  local  condition 
is  often  materially  benefited  by  the  healing  of  patches  and 
relief  from  the  concomitant  symptoms. 

Psoriasis. — In  this  condition  radium  has  been  employed 
upon  some  of  the  local  areas  with  success;  application  is 


ACNE  185 

made  through  thin  screens  of  aluminium,  or  in  some  instances 
the  bare  varnished  applicator  has  been  applied  to  the  affected 
area.  Short,  frequent  applications  have  usually  caused 
rebellious  localized  areas  to  yield.  Where  the  disease  is 
extensive  and  spreads  over  a  large  area,  the  application  of 
the  Roentgen  rays  may  be  more  desirable,  and  equally  good 
results  have  been  reported  by  this  method. 

Xeroderma  Pigmentosa. — Xeroderma  pigmentosa,  a  rare 
disease  of  obscure  origin,  begins  early  in  life,  and  is  pro- 
gressive, attended  by  pigmentation,  telangiectasis,  cutaneous 
atrophy,  and  tends  toward  malignancy,  usually  ending 
fatally.  This  condition  has  been  treated  but  not  success- 
fully/ 

Acne,  under  ordinary  circumstances  does  not  call  for 
radiation,  and  only  those  cases  that  have  been  refractory 
to  other  forms  of  treatment  should  be  accepted.  The 
correction  of  general  systemic  disturbance  is  as  important 
where  radiation  is  to  be  employed  as  it  would  be  where  the 
ordinary  procedure  is  adopted.  Therefore,  if  the  causes  of 
these  cutaneous  eruptions  are  corrected,  there  is  very  little 
likelihood  of  recurrence.  The  beneficial  effect  of  radiation 
has  been  thought  to  be  due  to  the  effect  of  these  rays  upon 
the  bacterial  infection  of  the  disease;  it  would  seem,  how- 
ever, that  if  the  rays  were  powerful  enough  to  kill  these 
germs,  the  cells  of  the  affected  parts  would  suffer  also;  at 
the  same  time  the  radiation  given  is  usually  mild  and  is 
not  pushed  to  a  degree  that  would  likely  produce  such 
reaction.  Therefore  it  is  apparent  that  the  benefit  to  the 
condition  is  due  merely  to  the  increased  cellular  activity, 
caused  by  the  stimulation  of  these  rays. 

Acne  vulgaris  has  been  successfully  treated  both  by  the 
Roentgen  rays  and  the  application  of  these  radio-active 


186  APPLICATION  IN  DERMATOLOGY 

salts.  Where  either  form  of  radiation  is  used  the  dosage 
must  be  mild  and  penetration  moderate;  usually  heavy  alu- 
minium, or  I  to  \  mm.  of  lead  foil.  A  number  of  successive 
treatments  should  be  given  at  stated  intervals.  Where  the 
Roentgen  rays  are  employed,  the  greatest  care  must  be 
observed  to  prevent  burns;  the  scarring  in  this  event  is 
often  worse  than  the  previous  existing  condition. 

Where  deep  pits  with  numerous  small  keloids  exist  as  the 
result  of  large  pustules,  treatment  adopted  for  their  relief 
must  be  considered  individually.  Under  such  circumstances 
radium  is  best  employed,  as  it  can  more  easily  be  placed 
over  these  small  areas  and  the  amount  of  radiation 
governed  entirely  by  the  amount  of  redundant  tissue. 
Rhinophyma,  hypertrophic  acne,  and  acne  rosacea,  the  effects 
of  the  later  stages  of  this  disease,  may  be  generally  benefited 
by  the  action  of  either  the  Roentgen  rays  or  these  radio-active 
salts.  The  treatment  in  this  condition  is  somewhat  different 
from  that  of  the  preceding.  In  administering  the  radiation 
it  must  be  given  with  the  intent  of  producing  contraction 
of  the  tissue;  thereby  causing  an  absorption  of  the  excess 
of  fibrous  tissue  and  a  lessening  of  the  vascular  supply. 
The  dosage  must  not  be  pushed  to  the  extent  of  causing 
intense  reaction,  otherwise  ulceration  and  scarring  will 
result.  A  reaction  of  mild  degree  is,  however,  necessary, 
and  when  once  established,  should  be  allowed  to  subside 
before  further  treatment  is  instigated.  By  several  succes- 
sive series  of  applications,  contraction  of  the  tissues  can 
be  established. 

Syphilis. — The  conditions  of  this  disease  usually  placed 

under  treatment  have  in  most  instances  been  mistakes  of 

? 

diagnosis;  large  gummatous  conditions  will,  in  the  great 
majority  of  cases,  yield  to  the  influence  of  radiation;  and  not 


LUPUS  VULGARIS  187 

until  they  have  recurred,  either  at  the  local  site  or  distant 
parts,  is  the  true  character  of  the  disease  recognized.  Treat- 
ment has  usually  been  established  upon  the  theory  that  the 
disease  was  of  a  malignant  nature,  or  possibly  that  of  lupus. 
The  instigation  of  the  proper  form  of  treatment  will  usually 
prove  the  error.  There  are,  however,  conditions  of  syphilis 
which  will  be  materially  benefited  by  radiation;  and  these 
conditions  are  where  the  ulceration  has  taken  a  very  low, 
indolent  form,  with  no  tendency  to  regeneration;  or  where 
this  ulceration  has  been  of  years'  standing  and  has  taken 
the  form  of  a  malignant  degeneration.  Under  these  circum- 
stances the  amount  of  radiation  must  be  in  proportion  to 
the  depth  of  tissue  involved,  which  is,  as  a  rule,  consider- 
able; therefore,  fairly  penetrating  rays  are  to  be  desired. 
Screens  of  about  \  mm.  of  lead  will  be  found  necessary. 
Radium  of  fairly  high  activity  should  be  employed.  In  con- 
junction the  usual  antisyphilitic  treatment  should  be  given 
and  continued,  as  it  would  be  under  ordinary  circumstances. 
The  effect  of  radiation  is  purely  local. 

Lupus  Vulgaris. — Lupus  vulgaris  is  a  tuberculous  affection 
of  the  skin  %  characterized  as  a  cellular  overgrowth  and 
infiltrations  terminating  in  ulceration.  The  degree  of  infec- 
tion and  the  amount  of  invasion  to  a  great  extent  determine 
the  form  of  treatment  to  be  employed.  Recurrence  under 
any  form  of  treatment  is  to  be  expected,  but  careful 
guarding  against  extension  of  the  process  will,  to  a  great 
extent,  prevent  the  extensive  tissue  destruction  that  is  so 
usual  in  these  cases.  In  the  milder  forms  of  this  disease 
treatment  by  the  Finsen  light  may  be  employed  where  it  is 
desirable,  but  the  length  of  time  and  the  trouble  in  making 
the  application  deter  many  from  making  use  of  this 
method;  at  the  same  time  the  results  from  the  Roentgen 


188  APPLICATION  IN  DERMATOLOGY 

or  radium  rays,  with  shorter  periods  of  application,  are 
just  as  efficient  and  are  cosmetically  equal.  In  the  later 
stages  of  this  disease  the  Finsen  light  is  of  no  value,  and 
therefore  the  other  methods  of  radiation  must  be  employed. 
The  ultraviolet  ray  given  off  by  the  Finsen  light  has  very 
little  power  of  tissue  penetration  and,  in  those  cases  where 
it  is  employed,  pressure  must  be  made  over  the  site  of 
disease  to  press  out  the  unnecessary  blood  supply;  a 
quartz  lens  being  employed  for  this  purpose.  These  rays 
will  penetrate  quartz  and  are  blocked  by  ordinary  glass. 
The  comparison  of  other  low  rays  is  rather  interesting,  as 
the  degree  of  penetration  existing  between  them  is  not  to 
be  regarded  in  proportion  to  the  thickness  of  the  article 
that  is  supposed  to  block  them. 

In  the  treatment  of  lupus  vulgaris,  where  the  ulceration 
has  caused  extensive  destruction  of  the  skin  with  infiltra- 
tion of  fibrous  tissue,  several  conditions  must  be  carefully 
avoided.  The  scar  tissue  which  has  formed  where  the 
ulceration  has  previously  existed  is  of  low  grade  and 
lacks  vitality.  If  radiation  is  pushed  with  much  vigor  it  is 
apt  to  break  down,  whereas  in  other  portions,  where  the 
overgrowth  has  been  excessive,  giving  rise  to  considerable 
thickening,  absorption  is  desired.  In  those  cases  where  the 
skin  naturally  possesses  a  high  degree  of  pigmentation, 
as  in  the  colored  race,  radiation  must  be  employed  care- 
fully; otherwise  the  pigment  will  be  removed,  giving  an 
unsightly  appearance  should  the  disease  exist  upon  ex- 
posed parts.  At  times  the  accident  is  unavoidable. 
Warning  should  always  be  given  upon  this  point  before 
adopting  measures  for  treatment.  Wichman,  of  Hamburg, 
has  devoted  considerable  study  to  the  treatment  of  lupus 


LUPUS   VULGARIS  189 

with  radium,  and  reports  a  series  of  30  cases  to  show  the 
liability  to  recurrence.    Of  the  23  that  have  been  treated: 

4  patients  remained  free  from  recurrence  for  four  years. 
8  patients  remained  free  from  recurrence  for  three  years. 
6  patients  remained  free  from  recurrence  for  two  years. 
4  patients  remained  free  from  recurrence  for  1  year. 

The  majority  of  these  cases  had  been  previously  treated 
by  other  methods,  and  represented  all  stages  of  the  disease. 

Localized  tuberculous  ulcerations,  usually  caused  by  direct 
infection,  have  been  treated  with  radium  and  Roentgen 
rays.  The  methods  adopted  are  exactly  the  same  as  in 
deep  infections  of  the  skin  from  other  diseases.  As  these 
local  tuberculous  ulcerations  are  likely  to  cause  infection  of 
the  deeper  structures  of  the  body,  care  must  be  exercised 
after  healing  the  local  condition  lest  the  patient  develop  a 
general  tuberculous  infection. 

Lupus  Verrucosus. — Wickham  (Radium  Therapy)  advises 
that  where  this  condition  exists  the  wart-like  growth  be 
removed  by  electrocautery  and  followed  by  applications  of 
radium  to  the  base  of  the  ulcers  caused  by  the  removal  of 
the  growth. 

Lupus  erythematosus  has  been  most  refractory  to  all 
forms  of  treatment  previously  recommended,  and  where 
radium  has  been  properly  employed  good  results  followed. 
The  applications  must  be  made  with  fairly  strong  radium; 
the  area  of  radiation  must  extend  well  beyond  the  defined 
line  of  disease. 


CHAPTER   XII. 
APPLICATION   IX   OPHTHALMOLOGY. 


Action  upon  Inflammatory  Conditions — Tuberculous  Infections — 
Trachoma — Spring  Catarrh — Glaucoma — -Keloids — Scars  upon  the  Lids, 
and  Other  Local  Conditions. 


Inflammatory  Reaction. — Radium  has  been  employed  in 
the  treatment  of  small  epitheliomas  upon  the  skin  or 
mucous  membrane  occurring  about  the  orbit,  and  if  prop- 
erly applied  there  is  practically  no  danger  of  injuring  the 
contents  of  the  eyeball.  The  slight  erythema  produced 
as  reaction  often  causes  the  soft  tissue  in  and  about  the 
orbit  to  swell  to  an  alarming  degree;  this,  however,  subsides 
rapidly,  leaving  the  structure  in  a  perfectly  normal  condition. 
This  amount  of  reaction  is  rarely  observed  in  other  portions 
of  the  face  from  the  same  dosage ;  and  while  these  ulcerations 
often  heal  with  very  little  reaction,  they  are  more  likely 
to  recur.  The  treatment  of  tumors  such  as  small  warts  and 
papillomata  in  this  region  does  not  differ  from  that  in  other 
portions  of  the  body ;  only  where  it  is  possible  the  sensitive 
portions  of  the  eye  should  be  carefully  guarded  against  all 
unnecessary  reaction. 

The  treatment  of  tuberculous  infections  of  the  eye  has  been 
studied  from  an  experimental  stand-point,  but  so  far  no 
practical  deductions  have  been  made  that  would  be  of 
clinical  value;  the  fact  that  radiation  retards  the  growth 
of  bacteria  would  suggest  that  it  might  prove  useful  in 


SPRING  CATARRH  191 

these  tuberculous  infections.  Lupus  vulgaris  about  the 
eyelids  has  been  successfully  treated. 

Trachoma. — Trachoma  has  been  treated  by  the  application 
of  both  radium  and  mesothorium  with  varying  results  by  a 
number  of  authorities.  In  some  instances  it  has  been  of  the 
greatest  value  in  causing  a  subsidence  of  the  inflammation, 
absorption  of  the  granulations,  and  even  the  clearing  of  a 
pannus  where  it  existed.  From  other  sources,  the  reports 
have  not  been  so  enthusiastic;  some  even  stating  that  very 
little  improvement  could  be  noticed  after  the  applications, 
and  that  where  pannus  existed,  no  improvement  could  be 
expected. 

The  applications  were  made  by  everting  the  eyelids  and 
holding  them  in  position  with  the  fingers  or  some  instru- 
ment, keeping  them  moist,  when  necessary,  with  a  little 
salt  solution,  then  placing  the  applicator  in  position  and 
allowing  it  to  remain  for  five  or  ten  minutes  at  each  sitting. 
The  amount  of  radium*  or  mesothorium  employed  was 
from  1  to  10  mg.,  and  usually  about  a  dozen  applications 
were  made.  These  applicators  were  not  filtered;  the  salts 
were  simply  encased  in  thin  glass  tubes,  therefore  the 
/3-  and  7-radiations  were  employed.  Care  was  taken  not 
to  expose  the  eyeball  too  long  at  any  one  angle.  Some 
remarkable  results  have  been  seen  in  the  treatment  of  this 
disease  with  the  Roentgen  rays;  they  are,  however,  by  no 
means  constant. 

Spring  Catarrh. — Spring  catarrh  has  been  treated  by  radium 
and  results  have  been  reported  to  the  effect  that  it  did 
not  recur;  however,  the  disease  has  naturally  an  irregular 
course,  and  in  many  instances,  where  this  form  of  treat- 
ment has  been  most  skilfully  employed,  it  seemed  to  have 
very  little  influence  upon  it.  A  case  reported  by  Turner, 


192  APPLICATION  IN  OPHTHALMOLOGY 

of  Edinburgh  (Radium  Therapy,  London),  is  of  interest. 
The  illustrations  of  the  article  show  marked  improvement 
in  the  condition  of  the  healed  eye.  A  capsule  of  10  mg. 
radium  bromide  was  employed  over  the  eyelid  for  ten  minutes 
every  day.  Later  one  containing  1  mg.  was  substituted  on 
account  of  the  first  applicator  being  in  use  and  the  irregular 
attendance  of  the  boy.  The  improvement  occurred  in  about 
six  weeks,  during  which  time  he  received  32.5  mg.  hours. 

Vicious  Scars  or  Keloids. — Vicious  scars  or  keloids  occur- 
ring in  or  near  the  eye  should  be  treated  exactly  the  same 
as  when  occurring  in  other  parts  of  the  body  and  likewise 
the  same  results  are  to  be  expected.  It  is  not  uncommon 
to  find  a  hard,  unyielding  mass  of  fibrous  tissue  distorting 
the  softer  structure  shrink  and  leave  the  surface  soft  and 
pliable. 

Glaucoma. — Glaucoma  has  been  treated  by  Wickham 
(Radium  Therapy),  and  in  the  case  mentioned  the  result 
was  only  temporary.  The  technique  used  was  interesting: 
He  applied  the  radium  over  the  temporal  and  superciliary 
regions  only,  and  interposed  between  the  radium  and  the 
skin  a  rubber  sheet  of  1|  mm.  thickness  to  avoid  secondary 
radiation. 

Keratitis,  ulcers  of  the  cornea,  episclerosis,  chalazions, 
hypopyon  have  been  included  in  the  list  of  the  diseases 
treated,  and  very  good  results  have  been  reported  of  the 
relief  obtained  from  radiation  in  bad  cases  of  pterygium. 
Many  experimental  studies  have  been  made  upon  the  eyes 
of  living  animals,  causing  ulcers,  inflammatory  reaction  in 
in  the  cornea,  iris  and  changes  subsequent  thereto,  but  from 
a  practical  stand-point  very  little  has  been  gained. 

Radio-active  salts  cause  a  peculiar  luminescence  of  the 
eyeball,  which  is  perceived  to  some  extent  in  persons  who 


OPACITIES  OF  THE  CORNEA  193 

are  blind  from  opacities  of  the  cornea  or  vitreous,  but  free 
from  diseases  of  the  nerve.  The  cause  of  this  is  unknown, 
but  for  some  time  it  was  thought  possibly  it  would  give  a 
method  to  the  blind  whereby  they  could  see  under  these 
conditions,  and  while  it  remains  of  physiological  interest, 
nothing  of  practical  value  can  be  developed  from  this 
rather  curious  phenomenon. 


13 


CHAPTER   XIII. 

APPLICATION  IN  DISEASES  OF  THE  EAR,  NOSE, 
AND  MOUTH. 


Inflammatory  Diseases — Deafness — Tinnitus  Aurium — Nasal  Polypi — 
Diseases  of  the  Mucous  Membrane  —  Caries  —  Pyorrhea  —  Malignant 
Diseases. 


AT  times  the  application  of  either  radium  or  mesothorium 
will  be  found  to  be  valuable  in  certain  inflammatory  diseases 
of  the  ear;  and  the  relief  from  tinnitus  aurium,  with  improve- 
ment in  the  hearing,  has  been  reported ;  instances  depending 
upon  some  sclerotic  change  or  where  a  suppurative  process 
exists  may  be  altered  and  benefited  to  a  marked  degree. 
Hagel1  reports  a  series  of  16  cases  with  decided  improvement 
in  about  one-half;  all  but  2  cases  were  benefited;  their  ages 
ranged  from  six  to  sixty-nine  years.  Applications  were 
usually  made  back  of  the  ear  in  several  very  short  treat- 
ments, from  one-half  minute  to  ten  minutes,  every  few 
days,  with  an  intermission  of  several  weeks  or  months;  the 
amount  of  radium  or  mesothorium  employed  being  about 
5  mg.  without  filter.  At  other  times  the  emanation  of 
radium  was  used  by  inhalation  and  baths. 

Polypi  of  the  nasal  tract  or  those  that  occur  in  the  external 
auditory  meatus  may  be  treated  with  radium,  and  a  number 
of  interesting  cases  have  been  reported  where  they  have 
been  successfully '  removed  from  the  larynx  and  trachea. 

1  Munch,  med.  Woch..  September,  1913. 


POLYPI  OF  THE  NASAL  TRACT        195 

Different  forms  of  applicators  have  been  devised  to  carry 
the  capsule  containing  the  radio-active  element  directly 
to  the  part,  and  where  this  is  possible  the  effects  are  rendered 
more  certain  and  there  is  less  likelihood  of  disturbing  the 
surrounding  tissue.  Where,  however,  this  is  not  possible  a 
series  of  exposures  by  the  "cross-fire"  method  will  doubtless 
accomplish  the  result. 

The  absorption  of  fibrous  tissue  is  one  of  the  most  marked 
features  of  these  radio-active  elements  and  Kantas1  reports 
a  case  of  tracheal  stenosis  that  was  completely  absorbed 
by  the  use  of  radium. 

Psoriasis  occurring  upon  the  mucous  membrane  of  the 
mouth  has  been  treated  by  Wameknos2  with  success,  and  he 
has  also  found  it  to  be  of  value  in  pyorrhea  alveolaris.  In 
the  treatment  of  most  of  these  cases  he  employed  a  strong 
solution  of  the  emanation  wrhich  was  held  in  the  mouth 
or  sprayed  upon  the  diseased  parts.  At  times,  where  it  was 
possible,  he  employed  an  apparatus  that  would  carry  the 
emanation  in  air  into  the  buccal  cavity.  The  principal 
object  is  to  allo\v  the  emanation  to  be  in  contact  with  the 
part  as  long  as  possible  for  its  action  upon  the  pus-forming 
organism. 

In  some  cases  of  dental  caries  the  employment  of  cocoa 
butter  charged  with  the  emanation  will  be  found  useful. 

Malignant  diseases  of  these  cavities  often  gain  head- 
way to  such  an  extent  before  being  recognized  that  an 
operative  procedure,  from  a  surgical  stand-point,  would 
not  insure  any  permanent  relief.  These  cases  are  strictly 
to  be  included  in  the  field  of  radiation.  Under  some  cir- 
cumstances the  Roentgen  rays  may  be  selected,  but  in  those 

1  Wiener,  med.  Woch.,  1912,  p.  1190. 

2  Berl.  klin.  Woch.,  June,  1913. 


196     DISEASES  OF  THE  EAR,   NOSE,  AND  MOUTH 

instances  where  it  cannot  be  brought  in  direct  contact  with 
the  disease,  it  will  be  found  to  yield  sooner  and  with  more 
certainty  to  the  effects  of  these  radio-active  salts.  The  tech- 
nique employed  in  the  treatment  of  these  tumors  will  be  con- 
sidered under  their  respective  classes.  Tuberculous  ulcera- 
tions  of  the  mucus  of  the  mouth  and  nasal  cavities  yield  to 
radiation  from  the  Roentgen  rays  as  readily  as  they  do  to 
these  radio-active  elements;  therefore  the  choice  is  merely  a 
matter  of  convenience.  The  proper  diagnosis  of  this  con- 
dition is,  however,  at  times  most  difficult  as  it  so  closely 
resembles  syphilis  and  malignancy.  The  error  often  leads 
to  considerable  embarrassment  and  disappointment  in  the 
ultimate  results. 


CHAPTER   XIV. 

APPLICATION  IN  DISEASES  OF  THE  GENITO- 
URINARY SYSTEM. 

Cystitis — Sexual  Neurasthenia — Inflamed  Prostates — Enlarged  Prostates — 
Chronic  Urethritis — Venereal  Warts — Tumors — Malignant  Diseases. 

IN  diseases  of  the  genitourinary  system  radio-activity 
has  been  employed  locally  for  its  effect  upon  inflammatory 
conditions  and  their  products,  tumors,  malignant  disease, 
and  in  the  aged  for  enlarged  prostates.  The  local  applica- 
tion in  sexual  neurasthenia  seems  to  have  afforded  some 
relief,  doubtless  due  to  the  action  upon  the  often  inflamed 
prostate  and  neck  of  the  bladder.  Usually  in  these  cases 
the  local  treatment  is  accompanied  by  the  use  of  radio- 
active waters  taken  internally  and  also  as  baths.  The 
internal  administration  may  prove  useful  in  cystitis  and 
allied  conditions  of  inflammation.  Even  when  it  is  accom- 
panied with  a  mild  albuminuria,  it  will  clear  the  urine  of 
both  mucus  and  pus  by  the  action  of  the  emanation,  which 
under  these  circumstances  acts  as  a  urinary  antiseptic. 

The  usual  method  adopted  in  these  cases  is  the  drinking 
of  large  quantities  of  water  containing  the  emanation  of 
radium  (best  taken  by  continued  sipping),  as  by  this  method 
the  system  is  continually  saturated  with  the  emanation, 
while  if  taken  rapidly  in  three-,  four-,  or  five-glassful  doses 
daily,  shortly  after  the  water  has  reached  the  stomach  the 
greater  part  of  the  emanation  will  be  eliminated  by  the  lungs. 


198     DISEASES  OF  THE  GEN  I  TO-URINARY  SYSTEM 

Under  the  same  form  of  treatment  cases  of  pyelitis,  pyelo- 
nephritis, and  interstitial  nephritis  will  also  be  decidedly  bene- 
fited. In  gout,  where  radio-active  waters  are  employed  they 
should  not  contain  as  high  a  percentage  of  emanations  as 
those  in  the  inflammatory  disease.  It  should  be  understood 
that  large  amounts  of  water  must  be  taken  into  the  system 
to  act  as  a  flush,  and  by  its  diuretic  action  upon  the  kidneys 
give  rise  to  free  elimination  which  will  relieve  these  conditions. 

In  conditions  of  sexual  neurasthenia  these  waters  are  usually 
employed  as  local  injections  into  the  rectum  and  bladder; 
this  should  be  accompanied  by  sitz-baths,  and  certain 
amounts  should  be  taken  internally  by  the  mouth.  Waters 
containing  a  high  charge  of  emanation  should  be  used. 
A  number  of  reports  have  been  made  of  great  improvement 
in  these  cases,  although  it  must  be  realized  that  in  a  condi- 
tion such  as  this  the  psychical  element  no  doubt  plays  an  im- 
portant role.  Possibly  the  routine  adopted  in  the  treatment 
of  these  cases  accounts  to  some  extent  for  their  improve- 
ment. Where  inflammation  of  the  prostate  or  neck  of  the 
bladder  actually  exists,  the  application  of  radium  locally, 
in  strength  enough  to  produce  a  slight  reaction,  will  be 
found  helpful  in  aiding  the  parts  to  regain  their  natural 
tone. 

Enlargement  of  the  prostate  in  old  men,  with  the  conditi<jn 
attending  upon  it,  can  often  be  relieved  by  the  local  applica- 
tion of  radium.  Desnos1  reports  a  series  of  46  cases  in 
which  13  were  absolutely  relieved  of  all  their  distressing 
symptoms  of  painful  and  frequent  micturition,  with 
improvement  in  the  urine  and  considerable  shrinking  of 
the  prostate  gland.  The  applications  were  made  through 

1  Bull.  Med.,  No.  95. 


CHRONIC  URETHRITIS  199 

the  urethra,  also  through  the  rectum;  but  no  mention  was 
made  of  application  through  the  perineum.  The  amount 
of  radium  power  employed  was  from  10  to  50  mg. ;  the  time 
of  application  varying  from  twenty  minutes  to  two  hours. 
The  applicators  were  protected  by  filters  so  as  to  eliminate 
the  low  |8-  and  7-rays  and  no  untoward  symptoms  followed 
the  applications. 

In  obstinate  cases  where  the  applications  to  the  prostate 
through  the  urethra  and  the  rectum  cause  disturbing 
symptoms,  there  is  no  reason  why  applications  over  the 
pubis  and  perineum  should  not  be  made,  as  it  gives  another 
line  of  cross-fire  which  under  conditions  such  as  chronic 
prostatitis  should  be  employed,  as  further  local  inflamma- 
tion will  certainly  add  to  the  distress  and  discomfort  of  the 
individual;  therefore,  all  means  should  be  taken  to  strictly 
guard  against  it.  Some  reports  have  been  made  where 
benefit  was  derived  from  the  application  of  the  bath  and 
the  drinking  of  emanation  waters. 

Chronic  Urethritis. — Chronic  urethritis  due  to  vegetations 
along  the  urinary  tract  have  been  treated  with  fair  results 
from  the  local  application  of  radium,  not  necessarily  placed 
upon  the  spot,  but  by  cross-fire  methods  from  without. 
Here,  as  in  other  places,  the  low  rays  of  radium  are  not 
desirable  on  account  of  their  irritation,  which  should  be 
avoided. 

Warts  and  external  vegetations,  especially  in  women,  from 
old  gonorrheal  discharges  that  show  a  tendency  to  recur 
after  other  forms  of  treatment,  may  be  benefited  and 
permanently  healed  by  radiation. 

Benign  tumors  of  the  bladder  have  been  treated  with  radio- 
active salts  either  from  within  through  a  cystoscope,  making 
the  applications  direct,  or,  in  those  cases  where  operations 


200     DISEASES  OF  THE  GEN  I  TO-URINARY  SYSTEM 

have  been  performed,  through  the  opening  of  the  wound, 
which,  while  it  aids  in  being  able  to  follow  the  process,  is 
by  no  means  necessary.  Many  tumors  of  the  bladder  have 
been  treated  from  without  by  applying  the  radio-active 
element  upon  different  places  near  the  bladder,  always 
directing  the  rays  by  cutting  off  the  lines  of  radiation  that 
are  not  desired,  filtering  with  heavy  lead,  frequently 
changing  the  position  of  the  element;  and  by  always 
keeping  the  line  directly  upon  the  tumors  it  is  possible  to 
completely  absorb  the  undesirable  tissue  without  harm  to 
the  surrounding  structures.  Papillomas  are  the  most  usual 
benign  growth  occurring  in  the  bladder  near  the  neck. 

Carcinoma  of  the  prostate  occurring  in  15  cases  was 
treated  by  Pasteau  and  Degrais.1  The  relief  was  a  sub- 
sidence of  hematuria  in  some,  while  in  others  the  disease 
was  to  a  considerable  extent  improved;  even  the  sur- 
rounding lymphatic  glands  became  smaller  from  the  effects 
of  the  treatment.  The  capsule  containing  the  radium  was 
introduced  into  the  bladder,  the  rectum,  and  in  some  cases 
through  a  perineal  wound.  Treatment  occupied  from  three 
to  four  hours,  a  few  days  apart;  five  or  six  sittings  were 
given,  followed  by  one  month  of  intermission.  They  par- 
ticularly mention  that  radium  should  never  be  introduced 
into  an  empty  bladder.  As  the  results  from  the  regular 
operative  procedure  have  been  so  poor  in  this  disease,  this 
method  is  believed  by  these  authors  to  be  a  decided  advance. 

Carcinoma  of  the  bladder  that  has  reached  the  stage  where 
operative  interference  can  no  longer  be  regarded  as  a  proper 
procedure  may  often  be  relieved  by  the  use  of  radio-active 
waters  applied  locally.  It  will  be  found  that  the  pain  will 

1  Jour.  d'Urol.,  Paris,  September,  1913. 


FIBROMA  201 

be  decidedly  lessened  as  will  the  bleeding.  This  also  allows 
to  some  extent  a  recuperation  of  vitality.1 

Fibrous  scars  of  penis  and  stricture  of  the  urethra  have  been 
treated  and  benefited  by  softening  of  the  fibrous  tissues. 
The  condition  existing  here  resembles  to  some  extent  keloids 
existing  in  other  parts  of  the  body  and  should  be  treated  in 
exactly  the  same  manner. 

Fibroma  of  the  Penis. — A  rather  unusual  condition  was 
treated  by  Pinch.2  The  patient,  fifty-six  years  of  age,  de- 
veloped a  small  tumor  1  by  0.5  cm.  on  the  dorsum  of  the  penis 
behind  the  corona.  It  was  painful  at  times  and  caused  him 
considerable  annoyance.  Radium  treatment  reduced  it 
to  the  size  of  a  small  shot  and  since  that  time  it  has  not 
troubled  him. 

The  second  case,  fifty-one  years  of  age,  developed  a  tumor 
about  the  size  of  a  walnut  at  the  root  of  the  penis,  situated 
in  the  corpus  spongiosum;  it  was  of  about  nine  months' 
duration  and  was  not  painful,  but  caused  a  slight  retraction 
of  the  organ.  Four  treatments  of  six  hours  for  three  con- 
secutive days  were  given  at  intervals  of  six  weeks,  of  30 
mg.  of  radium  bromide  screened  by  2  mm.  of  lead,  fixed  at 
right  angles  over  the  tumor.  This,  like  the  first,  diminished 
until  it  became  the  size  of  a  pea,  when  it  gave  no  further 
trouble.  Both  cases  were  impotent  while  the  tumor  existed. 

Carcinoma  of  the  testicle  and  carcinoma  of  the  penis  have 
been  reported  treated  by  radiation,  but  results  have  not 
been  encouraging;  the  disease  in  this  locality  seems  to 
possess  a  marked  tendency  toward  rapid  metastasis  with 
rapid  extension. 

1  Lowenthal,  Grundriss  der  Rad.  und  Thor.,  Wiesbaden. 

2  London  Radium  Institute  Report,  1913. 


CHAPTER  XV. 
APPLICATION  IN  GYNECOLOGY 

Method  of  Application — External  Vegetations — Urethritis — Vaginitis — 
Metritis — Fibroid  Tumors — Malignant  Diseases. 

THE  application  of  radio-activity  in  diseases  of  women 
must  be  considered  from  two  stand-points :  those  where 
radiation  can  be  administered  from  without  and  the  others 
where  internal  applications  are  necessary.  Conditions 
requiring  applications  upon  the  external  surfaces  do  not 
differ  from  those  of  other  parts  of  the  body,  but  where 
internal  applications  are  to  be  made,  a  variety  of  instruments 
have  been  devised  to  carry  and  hold  the  radio-active  capsule 
in  the  bladder,  uterus,  vagina  or  rectum;  and  when  such 
instruments  are  employed,  aside  from  observing  the  natural 
surgical  precautions  adopted  for  their  introduction  and 
retention,  the  activity  of  the  element  must  likewise  be 
considered,  lest  processes  of  an  undesirable  nature  result. 

Radium  or  any  other  radio-active  salt  need  rarely  be 
introduced  into  the  body  of  the  uterus;  usually  as  much 
can  be  accomplished  by  other  means,  from  without,  by 
applying  the  radio-active  salt  in  different  positions,  so 
that  the  rays  cross  at  the  exact  spot  where  radiation 
is  desired,  thus  avoiding  internal  applications  and  the 
complications  that  are  likely  to  arise  from  accidents  sub- 
sequent to  its  use.  Under  certain  conditions  internal 
applications  are  necessary  and  for  this  purpose  small  cap- 
sules may  be  introduced,  having  a  string  attached  for 


APPLICATION  IN  GYNECOLOGY 


203 


their  removal.  After  placing  the  capsule  in  the  desired 
position  it  can  be  held  in  place  by  packing  with  gauze  or 
cotton  wool.  Certain  forms  of  stem  pessaries  have  been 
made  to  hold  these  capsules  in  position,  but  they  are  rarely 
necessary;  and  in  cases  that  tend  to  bleed  easily  they  are 
apt  to  provoke  alarming  hemorrhages.  The  same  con- 
dition pertains  to  the  use  of  a  uterine  sound  so  adjusted  as 
to  carry  upon  the  distal  end  the  capsule  of  radium.  If 
retained  within  the  body  of  the  uterus  for  any  length  of 
time  the  movement  of  the  body  in  coughing  and  breathing, 
as  well  as  the  voluntary  movements  where  extensive  diseases 
exist,  are  liable  to  produce  not  only  severe  hemorrhage  but 
perforation. 

FIG.  49 


Uterine  pessary,  opens  so  the  small  tube  of  radium  can  be  .placed 
in  the  upper  end. 

External  vegetations,  obstinate  to  other  methods,  may  be 
treated  by  the  application  of  radium.  The  wart-like  excres- 
cence may  be  removed  by  the  knife,  cautery  or  caustics,  and 
the  application  of  radiation  made  to  the  base  of  the  ulcer  left 
after  one  of  these  procedures.  This  saves  to  some  extent 
the  amount  of  time  used  in  radiating  the  surfaces  enough  to 


204  APPLICATION  IN  GYN ECOLOGY 

cause  absorption;  where  it  is  desirable,  however,  the  masses 
can  be  treated  by  radium  alone  and  depend  entirely  upon 
the  radio-activity  for  their  removal.  Radium  should  be 
applied  with  a  filter  of  about  |  mm.  lead  and  the  part 
radiated  enough  to  cause  some  reaction. 

Chronic  urethritis  is  usually  due  to  deep  infection  of  the 
urethral  gland  or  small  wart-like  growths  along  this  passage. 
Application  of  radium  in  sufficient  strength  and  time  to 
produce  a  rather  severe  reaction  has  greatly  benefited  some 
of  these  cases.  Wickham  recommends  a  number  of  short 
applications  made  the  same  day,  with  intervals  of  one  day. 
Reports  have  not  been  published  upon  this  subject  and 
therefore  the  proper  technique  cannot  be  considered. 

Metritis. — Metritis  of  the  catarrhal  type  has  been  success- 
fully treated  by  the  internal  application  of  radium.  Wickham 
uses  a  stem  pessary  where  the  distal  end,  for  a  distance  of 
two  inches,  is  covered  with  a  radium  varnish;  the  strength 
of  the  varnish  differs  and  they  are  used  to  suit  the  require- 
ments of  the  individual  case.  A  series  of  cases  was  treated 
with  varying  degree  of  inflammatory  disturbance  and  all 
were  more  or  less  benefited;  some  were  markedly  improved. 
As  the  inflammation  subsided  the  uterus  became  smaller, 
discharged  less,  and  where  a  tendency  to  bleeding  existed  it 
was  also  relieved.  In  some  severe  types  a  pessary  was  used 
where  the  stem  contained  90  mg.  of  radium  salt  protected 
by  0.03  mm.  aluminium  foil  and  several  sheets  of  rubber. 
The  lower  end  was  protected  by  0.1  mm.  of  lead  foil.  Appli- 
cations made  with  this  strength  of  radium  were  of  five  to 
twenty  minutes  duration  every  other  day.  Where  it  was 
left  for  a  longer  time  lead  or  silver  filters,  from  0.1  to  0.5 
mm.,  were  used,  and  the  interval  between  treatments  was 
increased  at  the  same  time. 


FIBROMA  205 

Fibroma. — Radium  in  the  treatment  of  these  tumors  may 
either  control  the  bleeding,  with  only  a  slight  reduction  in 
the  size  of  the  tumor,  or  cause  the  tumor  with  its  concomi- 
tant symptoms  to  disappear  entirely.  A  few  cases  fail  to 
react  at  all.  It  must  also  be  remembered  that  radiation 
from  the  a>ray  has  also  produced  these  results;  therefore 
too  much  credit  must  not  be  given  to  these  radio-active 
elements.  In  fact  many  authors  believe  that  the  former 
mode  of  radiation  is  superior  and  that  an  extremely  high 
degree  of  Roentgen  technique  has  been  attained  in  this  field. 
Where  radium  is  to  be  employed  it  may  be  used  internally, 
externally,  and  combined;  the  advantage  seems  to  be  with 
the  last  method.  In  some  instances  the  application  of  the 
Roentgen  rays  has  been  combined  with  radium,  thereby 
giving  the  advantage  of  both  forms  of  radiation. 

In  selecting  these  cases  for  treatment  a  correct  diagnosis 
is  most  important;  ovarian  cysts  and  tumors  of  a  malignant 
nature  must  be  excluded.  The  cases  responding  best  to 
radiation  are  those  that  grow  slowly;  the  rapid  type  rarely 
respond ;  those  in  later  life  yield  better  than  those  appearing 
early;  Pinch1  reports  a  young  woman  of  twenty-six  years 
with  a  fibroid  the  size  of  a  three-months  pregnant  uterus; 
the  cervix  was  hypertrophied,  elongated,  and  edematous.  For 
three  years  she  had  suffered  from  dysmenorrhea  and  menor- 
rhagia,  which  had  steadily  increased  in  severity;  curettement 
had  been  performed  about  one  year  previous  with  some  relief, 
but  the  symptoms  gradually  increased  and  hysterectomy  was 
advised.  Two  series  of  five  treatments,  about  six  weeks 
apart,  were  given  with  100  mg.  of  radium  screened  with 
2  mm.  of  lead;  the  effects  of  which  caused  the  next  men- 
strual flow  to  be  decidedly  less. 

1  Rep.  Radium  Inst.,  London. 


206  APPLICATION  IN  GYNECOLOGY 

Oudin  and  Verchere1  treated  cases  of  fibroma  by  placing 
in  the  uterus  a  capsule  of  27  mg.  of  radium  bromide  in  a 
glass  tube  surrounded  by  an  aluminium  capsule;  decided 
benefit  resulted  from  these  applications. 

Malignant  disease  of  the  female  genital  organs  may  be 
regarded  as  one  field  where  radium  and  thorium  have  been 
more  efficient  than  any  other  form  of  treatment.  While 
the  results  have  by  no  means  been  ideal,  a  certain  number 
of  hopeless  cases  have  been  restored  to  health  for  at  least 
a  temporary  period.  These  results  have  been  for  the  most 
part  cases  that  had  passed  the  operative  stage.  At  present 
early  and  thorough  surgical  operation  should  be  advised  for 
all  these  malignant  conditions  occurring  in  this  region  as 
would  be  customary  in  other  fields  of  disease.  The  idio- 
syncrasies toward  radiation  are  too  numerous  to  risk  valu- 
able time.  Postoperative  radiation  certainly  can  do  no  harm, 
and  here,  as  in  other  fields,  it  is  only  a  matter  of  time  before 
it  is  universally  adopted.  When  the  case  has  passed  beyond 
the  stage  of  operation,  the  earlier  radiation  is  employed 
the  better  the  chances  for  recovery. 

Carcinoma  of  the  Uterus. — Cases  of  uterine  cancer  occurring 
about  the  cervix,  as  a  rule,  do  better  than  those  occurring 
in  the  body.  Pinch  has  summed  up  the  situation  as  follows: 

"In  cases  of  inoperable  malignant  disease  in  this  situa- 
tion radium  will  often  bring  about  results  which  cannot  be 
obtained  by  any  other  known  method  of  treatment.  Hemor- 
rhage is  arrested,  the  discharge  is  diminished  in  amount  and 
rendered  inoffensive  in  character;  the  ulceration  is  healed, 
and  the  pain  is  greatly  relieved. 

"The  rate  of  growth  is  checked,  sometimes  completely 
arrested,  and  the  surrounding  infiltration  and  induration  are 

1  Bull.  Med.,  1906. 


CARCINOMA   OF   THE   UTERUS 


207 


so  much  lessened  that  in  but  few  instances  cases  previously 
declared  to  be  inoperable  have  failed  to  become  operable. 


FIG.  50 


Section  of  scar  tissue  from  a  case  of  adenocarcinoma  of  uterus.  One 
year  after  beginning  treatment.  Notice  the  evidence  of  carcinoma, 
although  the  woman  appears  to  be  in  perfect  health.  (Records  of  the 
American  Oncologic  Hospital.) 


"The  action  of  radium  is,  however,  only  local  and  though 
it  may  and  often  does  check  the  rate  of  growth,  yet  in  most 
cases  dissemination  will  sooner  or  later  occur  and  the 


208  APPLICATION  IN  GYN ECOLOGY 

disease  spread  to  parts  beyond  the  effective  range  of 
radium." 

The  amount  of  radium  used  in  the  treatment  of  these  cases 
is  from  50  to  100  mg.,  screened  with  2  mm.  of  lead  and  3 
mm.  of  rubber.  Exposures  should  be  prolonged,  lasting 
from  thirty  to  sixty  hours,  spread  over  a  period  of  from  five 
to  ten  days,  and  repeated  at  intervals  of  about  six  weeks. 
However,  some  cases  will  respond  to  extremely  small 
amounts  of  radium.  The  following  case  was  treated  with 
only  1  mg.  radium,  used  in  an  aluminium  applicator  covered 
by  a  glass  tube : 

Mrs.  M.  S.,  aged  fifty-four  years;  school  matron  by  occu- 
pation; came  under  observation  April  28,  1908.  Family 
history  was  negative.  She  was  the  mother  of  four  children; 
the  first  was  stillborn;  second  labor  was  twins;  she  then 
had  a  miscarriage,  and  last  a  normal  birth.  Menses  were 
always  profuse,  but  never  menstruated  after  her  last  labor, 
which  occurred  when  she  was  thirty-four  years  of  age.  She 
suffered  from  an  abscess  of  her  left  breast  with  every  child, 
although  her  children  could  always  depend  upon  the  right 
breast  for  nourishment.  Her  general  health  was  good  until 
about  a  year  previous,  when  a  sero-bloody  discharge  from 
the  vulva  was  noticed.  She  consulted  her  physician 
and  operation  was  advised.  A  few  months  later  she  con- 
sulted another  physician,  who  took  her  to  one  of  our  hos- 
pitals and  at  this  time  operation  was  not  deemed  advisable 
on  account  of  the  extensive  pelvic  involvement.  Local  treat- 
ments were  then  given  for  some  months,  but  as  conditions 
did  not  improve  radium  was  advised.  Local  examination 
at  the  time  showed  an  old  laceration  of  the  perineum  with 
a  rectocele;  the  anterior  vaginal  wall  did  not  descend;  the 
uterus  was  small  and  in  good  position;  the  lower  part  was 


CARCINOMA  OF  THE   UTERUS  209 

* 

fixed,  with  thickening  toward  the  bladder;  cervix  thin,  with 
a  large  cup-shaped  ulcer;  the  right  broad  ligament  was 
negative,  while  the  left  wras  much  thickened  and  there  was 
a  general  induration  of  the  upper  vaginal  walls.  Bleeding 
was  quite  free  after  the  examination  and  the  inguinal  glands 
on  both  sides  were  large  and  tender.  Histological  examina- 
tion made  by  Dr.  John  M.  Swan  of  a  specimen  removed 
from  the  ulcerated  area  showed  it  to  be  an  epithelioma  of 
a  squamous  type  of  cell. 

Applications  of  radium  were  given  three  times  a  week, 
each  treatment  lasting  for  one  hour. 

In  a  few  weeks  there  was  a  general  improvement  in  all 
symptoms;  there  was  less  pain,  the  discharge  was  not  so 
offensive  and  contained  less  blood.  It  might  be  stated  here 
that  the  douching  was  continued.  Local  examinations  were 
made  at  stated  intervals  and  very  little  improvement  was 
noted,  although  her  general  health  was  much  improved; 
this  \voman  continued  uninterruptedly  her  work. 

By  the  end  of  July  both  general  and  local  symptoms 
had  improved  to  such  an  extent  that  the  patient  decided 
to  leave  the  city  for  her  vacation.  In  six  weeks  she  returned, 
complaining  of  pain  as  well  as  hemorrhages.  Local  exami- 
nation showed  about  the  same  conditions  as  before,  except 
there  seemed  to  be  more  encroachment  upon  the  posterior 
vaginal  wrall.  Routine  treatment  was  again  adopted  with 
the  same  general  and  local  improvement,  which  continued 
until  the  following  summer,  when  the  patient  decided  to 
visit  riends  in  a  neighboring  city.  Her  vacation  was 
limited,  for  at  the  end  of  two  weeks  a  recurrence  of 
hemorrhage  caused  her  to  return  home  for  further  treat- 
ment. The  following  summer  no  vacation  was  taken, 
nor  did  she  return  to  her  position  in  the  fall.  About  this 
14 


210  APPLICATION  IN  GYNECOLOGY 

time  she  developed  a  markedgeneral  cachexia,  while  the 
local  condition  remained  stationary. 

Early  in  October  the  patient's  stomach  became  rebellious 
and  could  not  be  controlled;  the  urine  was  choked  .with 
albumin,  possibly  due  to  a  nephritis;  delirium  followed  and 
within  ten  days  she  died. 

This  case  seemed  more  or  less  remarkable  because  of  her 
arduous  labors  for  two  years  and  six  months  from  the  time 
she  was  known  to  have  an  inoperable  cancer  of  the  cervix. 
At  the  same  time  she  was  spared  all  the  miseries  that  usually 
accompany  this  disease,  the  cause  of  death  being  a  toxemia, 
the  same  as  observed  in  cases  of  similar  disease  when  treated 
by  the  .r-ray,  where  the  local  conditions  are  greatly  improved 
but  where  there  is  a  general  sapping  of  the  system  from 
some  unknown  cause. 

The  local  condition  at  the  time  of  her  death  showed  very 
little  malignant  disease ;  unfortunately  postmortem  examina- 
tion was  refused. 

Carcinoma  of  the  vagina  responds  to  the  use  of  radium 
in  a  large  proportion  of  cases,  possibly  for  the  reason  that 
the  radio-active  salts  can  be  brought  in  closer  proximity 
with  the  disease,  or  the  condition  can  be  followed  with  a 
greater  degree  of  accuracy.  A  number  of  instances  of 
great  improvement  have  been  reported.  The  following  is 
an  example: 

Miss  B.,  aged  fifty-one  years;  factory  worker.  Previous 
history  contains  nothing  of  interest.  About  three  months 
before  coming  under  observation  she  experienced  consider- 
able uneasiness  in  the  pelvis  accompanied  with  some  distress 
when  passing  urine,  and  some  vaginal  discharge,  these 
symptoms  gradually  increasing  until  about  a  month  ago. 
She  visited  another  hospital,  where  vaginal  examination 


EPITUELIOMA  OF  THE   VULVA  211 

disclosed  a  mass  about  the  size  of  a  hen's  egg  in  the  left 
vesico-uterine  space.  The  mass  seemed  to  be  slightly 
movable  with  the  surrounding  structures,  but  otherwise 
was  fixed  and  tender,  but  not  painful.  Cystoscopic  exami- 
nation disclosed  an  excavated  ulceration,  about  the  size 
of  a  silver  quarter,  in  the  left  side  of  the  bladder,  cor- 
responding in  location  with  the  mass.  At  the  time  of 
her  admission  to  the  Oncologic  Hospital  the  growth  had 
extended  considerably  and  ulcerated  into  the  vagina  as 
well  as  the  bladder.  The  patient  was  extremely  weak  and 
practically  bedridden,  with  a  temperature  ranging  from 
subnormal  to  101°  F.;  most  of  the  time  from  99°  to  100°  F. 
She  had  a  very  foul  vaginal  discharge  and  painful  micturi- 
tion, and  was  taking  about  ^  gr.  of  morphia  several  times  a 
day  for  relief.  She  was  then  treated  with  radium  (11  mg.), 
filtered  only  by  about  \  mm.  of  aluminium  and  a  glass  tube; 
treatments  were  given  every  other  day  for  an  hour  until  she 
had  received  18;  this  was  followed  by  8  two-hour  treat- 
ments under  the  same  conditions.  Fourteen  weeks  after 
her  admission  to  the  institution  she  was  able  to  leave  and 
return  to  her  home.  Ulceration  had  healed  and  there 
only  remained  a  small  nodule  about  the  size  of  a  hickory 
nut;  all  symptoms  had  disappeared. 

Carcinoma  developing  from  the  ovary  or  in  the  ligaments 
has  been  treated  by  radiation;  the  results  are  about  the 
same  as  malignant  disease  occurring  in  other  portions  of  the 
abdomen.  Carcinoma  involving  the  bladder  in  the  female 
is  usually  from  extension  of  disease  from  the  neighboring 
parts,  and  is  rarely  primary. 

Epithelioma  of  the  vulva  responds  to  the  use  of  radium, 
with  a  fair  chance  of  ultimate  cure,  if  the  disease  has  not 
been  allowed  to  progress  too  far.  Involvement  of  the 


212  APPLICATION  IN  GYNECOLOGY 

inguinal  glands  lessens  the  chances,  as  it  is  probable  that 
the  pelvic  glands  are  also  involved.  The  disease  usually 
begins  near  the  mucocutaneous  junction  and  simulates  the 
condition  when  it  develops  upon  the  lip  in  its  tendency 
toward  metastasis.  If  some  operative  procedure  has  been 
performed,  postoperative  radiation  to  lessen  the  chances 
of  recurrence  should  be  used.  Under  such  conditions  the 
Roentgen  rays  will  be  found  of  most  value. 

Sarcoma. — Sarcoma  is  seen  occasionally  in  the  female 
pelvis  and  here  as  in  other  portions  of  the  body  may  run 
an  extremely  rapid  course,  or  grow  so  slowly  as  not  to  cause 
suspicion  as  to  its  exact  nature.  Treatment  by  radiation  is 
not  dependable  in  all  cases,  but  occasionally  brilliant  results 
are  seen. 


CHAPTER   XVI. 

APPLICATION   IX   EPITHELIOMATA  AM) 
CARCINOMATA. 

Consideration  for  Selection  of  Cases — Comparison  of  Published  Lists — 
Epithelioma  of  the  Face,  Lip,  Mouth,  Pharynx,  Larynx,  and  Hands — - 
From  Roentgen-ray  Burns  and  Degenerated  Scar  Tissue — Carcinoma  of 
the  Stomach,  Rectum,  Intestinal  Tract,  Liver,  Gall-bladder,  Pancreas, 
Breast,  and  Thyroid. 

WHEN  and  under  what  condition  radiation  should  be 
applied  to  malignant  diseases  is  a  difficult  question  to 
decide,  and  from  numerous  instances  of  recovery  reported 
by  competent  observers,  under  circumstances  that  appeared 
to  be  hopeless,  it  would  seem  that  there  is  no  limit,  and 
so  long  as  the  patient  has  vitality  to  breathe,  the  benefit 
of  the  doubt  should  be  given  and  the  application  made. 
There  are,  however,  more  or  less  distinct  limitations  which, 
while  not  defined,  are  of  value  in  the  selection  of  cases  for 
treatment  and  the  prognosis  as  to  the  amount  of  relief  to 
be  expected  or  ultimate  subsidence  of  the  process. 

Malignant  processes  that  are  inclined  to  remain  localized 
and  of  a  slow  course,  usually  yield  to  the  influence  of  radia- 
tion, and  if  the  disease  has  not  advanced  too  far  are  as  a 
rule  likely  to  remain  quiescent  for  years.  The  slower  the 
process  the  more  rapid  the  resolution.  When,  however, 
they  have  advanced  to  the  extent  that  the  surrounding 
tissue  has  suffered  materially,  or  upon  subsidence  of  the 
mass  the  ulcer  that  is  left  has  not  vitality  enough  to  produce 


214 


EPITHELIOMATA  AND  CARCINOMATA 


sufficient  granulation  tissue  to  bridge  over  the  damage 
done  by  the  growing  process,  the  same  or  similar  diseases 
soon  develop  in  the  ulcerated  portion,  leaving  the  individual 


FIG.  51 


11 

n 


Applicators  for  introduction  into  cavities;  the 
longest  for  use  in  the  esophagus  or  stomach.  The 
containers  usually  supplied  for  protection  of  the  cap- 
sule are  made  of  lead  with  walls  about  \  inch  thick, 
or  less  than  3  mm.;  therefore  they  do  not  confine 
the  gamma  radiator. 


in  practically  the  same  condition  as  before  treatment. 
Extensive  ulceration  need  not  necessarily  mean  a  gloomy 
prognosis,  as  even  in  recurrent  diseases  with  ulceration,  yet 
having  a  good  supporting  base,  it  is  quite  often  observed 


EPITHELIOMATA  AND  CARCINOMATA  215 

that  the  ulcer  and  malignant  process  will  yield  and  leave 
the  surface  of  the  skin  with  the  same  appearance  as  before 
this  recurrence;  even  in  some  instances  showing  the  opera- 
tive scar  with  stitch  marks.  At  times  large  tumors  with  the 
overlying  integument  inflamed,  broken  down,  and  necrotic 
from  pressure,  will  undergo  exactly  the  same  regeneration, 
so  that  upon  disappearance  of  the  tumor  there  is  practically 
nothing  to  be  observed. 

The  forms  of  malignant  diseases  that  are  rarely  benefited 
to  a  great  extent  by  radiation  are  those  that  tend  to  a 
rapid  metastasis;  even  when  treatment  is  applied  early  in 
these  cases  it  appears  to  be  of  very  little  value.  While  the 
local  condition  may  yield  to  the  influence  of  the  rays,  the 
likelihood  of  its  rapid  recurrence  in  some  other  portion  of 
the  body  is  to  be  expected.  Under  these  circumstances 
treatment  often  relieves  the  local  process,  causing  a  sub- 
sidence of  suffering,  with  less  mental  anxiety,  and  perhaps 
to  some  extent  prolongs  life;  and  in  many  instances  where 
the  local  manifestation  heals,  it  saves  the  sufferers  a  wound 
that  is  often  repulsive. 

The  application  of  radiation  to  these  cases  of  malignant 
disease  must  be  made  carefully,  for  it  is  possible  under  some 
circumstances  to  irritate  a  slow-growing  process  and  cause 
it  to  grow  more  rapidly,  thus  changing  an  inactive  condition 
into  one  of  rapid  proliferation;  or  where  a  low-grade  appli- 
cation of  activity  is  applied  over  a  long  period,  producing 
stimulation  instead  of  atrophy,  it  is  possible  to  cause  an 
entirely  new  malignant  process  to  replace  the  older  form. 
This  has  been  reported  on  several  occasions  where  sarcomas 
have  been  treated  for  a  long  period  and  the  radiation  has 
caused  a  proliferation  of  the  epithelium,  giving  rise  to 
carcinoma  of  greater  malignancy  than  the  sarcoma. 

If,  however,  the  radiation  has  been  pushed  to  the  other 


216 

extreme,  it  is  possible  to  produce  an  ulceration  that  fails  to 
heal,  leaving  a  focus  of  irritation  for  malignant  degeneration. 
The  prognosis  as  to  the  benefit  of  radiation  upon  individual 
cases  of  malignancy  must  be  determined  entirely  by  clinical 
observation.  The  histology  of  the  disease,  failing  to  give  any 
enlightenment  for  the  cellular  formation  of  these  processes, 
seems  to  have  very  little  significance,  and  is  often  contra- 
dictory. 

The  following  lists  from  several  sources  will  prove  inter- 
esting; they  have  been  selected  for  the  reason  that  it  is 
believed  they  are  unbiased,  and  the  knowledge  gained  from 
them  will  give  an  understanding  of  ultimate  results;  whereas 
a  compilation  of  cases  from  literature  reporting  only  bene- 
ficial results  is  likely  to  be  misleading: 

Beckel1  reports  a  list  of  54  cases  taken  in  all  stages  of 
disease: 

Total.  Improved. 

Larynx 2 

Tonsils  and  pharynx 2  1 

Arm 1 

Uterus 9  1 

Pancreas      2 

Breast,  primary      ...*...  4  2 

Breast,  secondary 10  3 

Cheek 1  1 

Lip   ...:.....  .      .  1 

Parotid 2  1 

Rectum 7  1 

Colon  and  mesentery         ....  3  1 

Esophagus -_  .       .       .  3 

Stomach 3 

Urethra        1 

Ovary 3 

54  11 

The  following  list  published  by  Mr.  Pinch2  is  most  com- 
plete and  is  of  unusual  importance,  having  been  taken  from 
an  article  written  in  a  most  conservative  manner. 

1  Modern  Radium  and  Thorium  Therapie,  Berlin,  1913. 
"  Brit.  Med.  Jour.,  1913. 


Diseases. 

Examined  but  not 
treated. 

Recently  treated  but 
results  not  yet  noted. 

Received  prophylactic 
irradiation  only. 

Apparently  cured. 

-6 
| 

U 

Improved. 

Not  improved. 

Abandoned  treatment. 

T3 

1 

Carcinornata,        squa- 
mous-celled     epithe- 
liomata,  buccal,  lin- 
gual and  pharyngeal 
mucous  membranes 
Larynx 

6 
2 

3 

1 

18 

10 

15 

9 

9 
3 

Cheek  and  hand  . 
Neck  and  scalp 

1 

3 

2 
1 

4 

3 
1 

2 

2 

Vagina  and  vulva 
Uterus        .... 
Penis    
Spheroidal-celled  breast 
Liver  and  gall-bladder 

1 
2 

1 
5 

3 
1 

9 

3 

1 

3 
19 
1 

34 

1 
2 

11 

1 

10 

15 

5 

12 
3 

Thyroid 

1 

1 

Paget's  disease 

1 

1 

Columnar-celled    large 
intestine 
Rectum      .... 
Stomach    .... 

2 
3 

1 

3 
2 

1 

1 
9 

?, 

6 

1 

1 
17 
2 

4 
2 

Ovary  
Testicle      .... 

1 

2 

1 

2 

Prostate     .... 

1 

1 

Rodent  ulcer  . 
Sarcomata,        spindle- 
celled      .... 
Round-celled  . 
Melanotic        .      .      . 

3 
1 

10 
1 

1 

7 

31 
1 

41 

4 
2 

12 

2 
3 

6 

1 
2 
2 

1 
2 
1 

Endothelioma 

1 

Lymphosarcomata     . 
Lymphadenoma  (Hodg- 
kin's  disease) 

1 

1 
1 

2 

Malignant    disease    of 
the  glands  . 
Parotid  tumor 
Abdominal  tumors     . 

1 

1 

2 

3 
4 
? 

1 

2 
1 

2 
1 

Mediastinal  tumors  . 

1 

Villous  tumor  of  bladder 
Granulomata 
Adenoma  of  breast    . 
Fibroid  disease  of  uterus 
Fibroma  of  penis 

3 

1 

1 

2 
1 

2 

2 
?, 

2 

1 

3 

1 

1 

1 

Enchondroma 

1 

Lcukoplakia    . 
Nevi,  capillary 
Nevi,  cavernous  . 
Moles,  warts,  and  papil- 
lomata   .... 

2 

2 

1 

1 

2 
3 
2 

6 

1 
25 

6 

1 
1 

2 

60 
6 

16 
3 
8 

41 
2 

89 
3 
2 
2 


9 
7 
4 
1 

10 

5 

1 

5 

2 

1 

3 

31 

10 

18 


218 


In  the  following  list  cases  were  not  selected,  and  only 
placed  under  treatment  with  radium  when  all  other  means 
failed.  Most  of  them  had,  where  it  was  at  all  possible, 
previously  received  radiation  from  arrays.  (Treated  at 
American  Oncologic  Hospital.) 


Diseases. 

Disease 
disappeared. 

Marked 
improvement. 

Improvement. 

Doubtful. 

2 

Unimproved. 

•6 

V 

5 

Remarks. 

Epithelioma: 
Ear         .... 
Eyelid 

2 

1 
3 

Those  placed  under 
left  were  improved 

1 

to     some     extent, 

Forehead 

3 

otherwise      would 

Hand      .... 

1 

1 

have  been  included 
under    the    unim- 

Lip    

?, 

1 

proved. 

Buccal  surface 

1? 

?     Operative  treat- 

Mouth  .... 

3 

i 

ment  substituted. 

Leukoplakia 
Nose  (rodent  ulcer) 
Palate    .... 
Pharynx 

1 
3 
1 

1 

1 

1 
5 

i 
i 

Scalp      .... 
Tongue 

1 

i 

Carcinoma: 
Axillae,  neck 
Breast,  recurrent    . 

1 

i 

3 

Colon     .... 
Face  and  neck 

1 

1 
1 

Doubtful    case 
placed  under  that 
group  as  diagnosis 
was  uncertain. 

Nose,  mucous  surface 
Palate    .... 

1 

1 
1 

Pharynx 

i 

Esophagus  . 
Rectum 
Tongue 

Tonsil     .... 

1 

i 
? 

1 
3 
2 

?, 

?     Improved    when 
he  left. 

Uterus,  body    . 

11 

1 

EPITHELIOMATA  AND  CARCINOMATA 


219 


1 

a 

S 

a 

Diseases  . 

03 

i 

o 

1 

Q. 
M> 

o    ft 

05      C3 

73    2 

a    c. 

o> 
> 

.2 

I 

=3  .S3 
w  "O 

iS  £ 

2 
o. 

a 

jt 

a 

3 

s  " 

g 

Q 

2 

5 

Uterus,  cervix  . 

2 

6? 

2 

4 

Uterus  and  vagina 

1 

Uterus,  vagina,  and 

bladder    . 

1 

Vagina  .... 

1 

Vagina  and  bladder 

i 

Papilloma: 

Chest     .... 

1 

Tongue 

•• 

•• 

Mouth,  leukoplakia 

1 

Cyst  (recurrent)  : 

Mouth   .... 

1 

Sarcoma: 

Antrum 

1 

Choroid. 

1 

Multiple 

1 

Orbit      .... 

l 

Orbit  (osteo)     . 

1 

Skull       .... 

1 

Sternum 

1 

Serocystic  (face) 

1? 

Remarks. 


?     Operative  treat- 
ment substituted. 


Died  of  angina  pec- 
toris,  chronic  heart 
disease. 


Case  not  confirmed 
by  operation  or 
section. 


?     Used  for  an  indi- 
vidual case. 


Epitheliomata  of  proliferative  type  usually  appear  first  as 
warts  or  crusts  and  may  be  easily  rubbed  off,  with  more  or 
less  bleeding,  which  under  some  circumstances  is  difficult  to 
check.  This  may  be  followed  by  healing.  When  the  process 
recurs  it  frequently  appears  in  a  slightly  exaggerated  form. 
If  the  ulceration  or  tumor  formation  has  only  involved 
the  superficial  layer  of  the  skin,  a  few  short,  active  treat- 
ments will  cause  a  rapid  healing;  if,  however,  the  ulceration 
has  extended  below  the  surface  and  involved  the  deep  layer 
and  muscles,  healing  depends  more  upon  the  possibility 


220 


EPITHEL10MATA  AND  CARCINOMATA 


FIG.  52 


of  the  new  tissue  finding  sufficient  structure  to  bridge  the 
gap.  Very  often  large  ulcers,  even  10  cm.  in  diameter,  ulcer- 
ated to  the  muscle,  will  yield  and  remain  in  good  condition. 

These  processes  are,  as  a  rule, 
very  slow  in  their  progress,  fre- 
quently extending  over  a  course 
of  ten  years,  and  several  have 
come  under  observation  with 
a  history  of  over  thirty  years. 
The  slow,  indolent  nature  of  the 
disease  makes  it  a  typical  one 
for  the  application  of  radiation. 
Metastasis  rarely  occurs  and 
even  in  the  cases  which  fail  to 
come  under  treatment,  death 
seldom  results  from  this  cause. 
The  process  involving  the  skin 
about  the  eye  invades  and  ex- 
tends inward  upon  the  mucous 
membrane,  where  it  is  likely  to 
give  rise  to  deep  pus  infections 
and  possible  meningitis.  When 
this  condition  occurs  upon  the 
forehead,  the  muscular  contrac- 
tion of  the  scalp  often  interferes 
with  healing;  but  if  this  is  taken 
into  consideration  and  the  part 
put  at  rest,  many  will  yield 
where  they  would  otherwise  fail. 
This  same  state  of  affairs  is 

often  observed  in  the  nose  about  the  alse,  which  at  the  same 

time  are  often  irritated  by  the  collection  of  sebiferous  matter. 

P^pitheliomata  of  this  character  occurring  upon  the  skin 


An  applicator,  with  the  lead 
screen,  glass  protector,  and  gauze, 
to  cut  off  the  secondary  radiation 
from  the  lead  filter  and  glass 
shield. 


EPITHELIOMATA   AND  CARCINOMATA  221 

of  other  parts  of  the  body  usually  yield  easily  to  radiation; 
except  those  involving  the  dorsal  surface  of  the  hand  which 
are  prone  to  recur.  When  ulceration  has  extended  so  far 
that  no  tissue  remains  upon  which  granulations  can  grow, 
radiation  in  any  form  will  fail.  Recurrence  either  at  the 
site  of  original  disease  or  upon  other  places  is  common; 
if,  however,  they  are  not  allowed  to  progress  they  usually 
yield  easily  to  treatment. 

Treatment. — The  mode  and  method  of  treatment  in  these 
cases  is  a  matter  of  election;  they  yield  as  readily  to  the 
Roentgen  rays  as  they  do  to  radium,  and  many  are  perma- 
nently healed  by  plasters  of  arsenic.  Radiation  has  in  its 
favor  that  its  application  is  painless  and  produces  less  scar- 
ring; therefore,  if  the  disease  is  upon  the  face  the  cosmetic 
effect  is  better,  and  the  result  is  more  likely  to  be  permanent. 

If  radium  is  to  be  elected,  application  should  be  made 
through  a  thin  filter,  only  thick  enough  to  cut  out  the 
low  /3-ray.  The  applications  under  these  circumstances 
should  be  short  but  in  proportion  to  the  amount  of  radium 
employed.  In  small  ulcers  of  little  depth,  2  mg.  applied 
in  several  applications  for  twenty  to  thirty  hours  have 
produced  healing.  This,  however,  is  not  to  be  recom- 
mended. The  usual  treatment  consists  of  the  application,  for 
two  hours,  of  a  50-mg.  applicator  with  0.1  mm.  lead  screen, 
and  proper  protection  from  secondary  radiation.  The  sur- 
rounding tissue  must  under  all  circumstances  be  carefully 
guarded.  Considerable  latitude  must  be  allowed,  due  to 
the  exigency  of  the  occasion.  The  following  case  illustrates 
the  condition: 

Mr.  Y.,  aged  sixty-nine  years;  Philadelphian  by  birth; 
about  four  years  ago  developed  a  small  sore  upon  the  side 
of  the  nose,  which  previously  had  been  scaly  for  several 
years.  (See  Figs.  53  and  54.)  It  had  been  treated  by 


222 


EPITHELIOMATA   AND  CARCINOMATA 


the  Roentgen  rays  and  yielded  easily,  but  remained 
healed  about  nine  months,  when  it  broke  down  again. 
At  the  time  he  came  under  treatment  the  ulcer  measured 
about  \  by  f  inches,  was  more  or  less  indolent,  and  cov- 
ered with  a  crust.  When  removed,  it  left  a  granulated 
surface,  which  did  not  tend  to  bleed.  Radium  treatment 


FIG.  53 


FIG.  54 


Epithelioma,  recurring  after  x-ray 
treatment,  treated  with  radium. 


After  treatment  (about  9  months). 


was  given  for  two  hours  every  other  day;  11  mg.  "ele- 
ment" being  protected  by  aluminium  and  glass  filters 
wrapped  in  rubber  tissue,  in  all  twenty-four  treatments. 
There  was  considerable  reaction,  which  caused  swelling  and 
induration  about  the  eye;  this  eventually  subsided,  and 
left  the  surfaces  in  a  normal  condition.  The  excessive 


RODENT  ULCER  223 

radiation  was  employed  in  this  case  on  account  of  the 
tendency  toward  recurrence. 

Rodent  Ulcer. — A  type  of  epithelioma  occurring  upon  the 
face;  usually  near  the  nose;  begins  generally  as  a  pustule, 
which  may  heal  and  recur  a  number  of  times;  however,  this 
healing  may  be  misleading,  as  often  only  a  thin  layer  of  tissue 
covers  the  underlying  disease.  In  time  the  ulcer  widens; 
edges  are  undercut  with  no  granulation  tissue  extending  above 
the  rim  of  the  crater-like  ulcer.  There  is  generally  a  slight 
inflammatory  area  surrounding  this  ulcer  which  bleeds  easily 
and  is  often  difficult  to  check.  The  ulceration  widens  and 
grows  deeper,  eroding  everything  in  its  path,  even  the  bone, 
leaving  a  cavity  with  ragged  wall  that  seems  to  possess 
no  inclination  toward  regeneration.  Sections  of  the  border 
show  the  same  histological  appearance  as  other  epitheliomas. 
This  process  is  frequently  placed  in  the  same  class  as  the 
proliferative  or  fungoid  type,  which  is  by  no  means  so 
malignant,  and  is  far  more  amenable  to  treatment.  Both 
types  remain  local,  rarely  giving  rise  to  metastasis. 

The  prognosis  in  these  cases  is  by  no  means  as  favorable 
as  in  those  attended  with  considerable  tissue  overgrowth. 
However,  in  the  early  stages,  when  the  disease  has  not 
invaded  the  deep  structures,  they  usually  respond  readily  to 
treatment.  Recurrence  is  common,  although,  with  the  proper 
amount  of  radiation,  this  to  some  extent  may  be  avoided. 

Treatment  in  Mild  Cases. — The  radio-active  salts  may 
be  protected  with  a  thin  sheet  of  aluminium,  or  applied 
entirely  without  a  filter.  The  radiation  from  a  10  mg. 
applicator  for  six  to  ten  hours  usually  proves  sufficient. 

Some  General  Considerations  of  Superficial  Epithelioma. — 
All  forms  of  epithelioma,  occurring  upon  the  face,  previously 
treated  with  caustics,  carbon  dioxide,  electric  needles,  ful- 
geration,  and  other  such  methods,  causing  the  formation  of 


224  EPITHELIOMATA  AND  CARCINOMATA 

hard  masses  of  scar  tissue  of  low  vitality,  must  be  considered 
as  unfavorable  cases  for  treatment,  as  the  character  of  the 
tissue  is  of  such  a  nature  that  upon  the  least  injury  exten- 
sive sloughing  is  likely  to  follow. 

It  will  be  found  that  many  cases  will  yield  to  the  use  of 
radium  which  have  been  rebellious  wrhen  previously  treated 
by  the  axray;  the  explanation  being  that  the  character  of 
the  rays  emitted  from  these  radio-active  elements  is  entirely 
of  a  different  nature. 

The  healing  of  these  ulcers  is  often  delayed  from  lack 
of  ordinary  care  in  cleansing  the  parts  of  discharges,  which 
dry  along  the  edges,  producing  an  irritation  from  their 
position  by  not  allowing  the  free  escape  of  pus ;  thus  causing 
further  breaking  down. 

Epithelioma,  occurring  upon  or  adjacent  to  the  mucous 
membranes  of  either  the  nose  or  mouth,  must  be  considered 
in  quite  another  class  from  those  occurring  fully  upon  the 
dermal  surfaces.  When  the  mucous  membrane  is  involved, 
the  disease  is  usually  very  rapid,  and  metastasis  occurs 
early.  It  appears  past  middle  life  as  a  small  wart-like 
growth  upon  the  lip,  which  tends  to  break  down  and 
bleed.  There  is,  however,  a  class  of  low-grade  epitheliomata 
occurring  upon  the  lip  that  is  extremely  indolent  and 
extends  slowly,  usually  observed  as  a  flat  ulcer  that  does 
not  go  deeply  into  the  tissue  and  involves  only  the  mucous 
membrane.  These  ulcers  usually  respond  easily  to  either 
.r-rays  or  radium;  and  when  once  healed  do  not  tend  to 
recur.  These  cases  must  not  be  confused  with  the  other 
form,  which  is  very  malignant  and  where  recurrence  after 
operation  is  extremely  common;  treatment,  either  primary 
or  secondary,  after  operation  with  the  .r-ray,  has  not 
yielded  results  at  all  satisfactory.  A  number  of  instances 
have  been  reported  where  there  has  been  a  recurrence  of 


LEUKOPLAK1A  225 

the  disease  locally  or  where  the  local  disease  has  not  recurred 
but  the  glands  of  the  neck  have  produced  a  large  tumor. 
Even  where  the  local  disease  and  metastasis  were  treated  by 
the  rays  of  radium  both  have  yielded  and  the  condition  has 
been  temporarily  arrested.  These  very  fortunate  results 
are  not  the  rule,  however,  the  malignancy  of  this  class  of 
cases  borders  upon  that  of  the  true  carcinoma  of  the 
glandular  class.  In  those  cases  that  do  not  yield  to 
treatment  the  pain  and  swelling  is  often  benefited,  at 
least  for  a  time,  and  the  course  of  the  disease  is  decidedly 
extended,  as  shown  in  Figs.  55,  56,  57. 

Wickham  mentions  treating  cases  of  this  type  with  an 
applicator  containing  0.04  gm.  radium  sulphate  filtered  by 
lead  0.6  mm.  thick,  application  extending  over  twelve  hours 
in  divided  sittings. 

Epithelioma  of  the  lip  has  been  successfully  treated  by 
Heinatz1  and  others.  Both  cases  were  of  extreme  types. 

Leukoplakia  is  often  associated  with  cases  of  epithelioma 
of  the  mucous  membrane  of  the  mouth.  The  course  of  the 
disease  is  often  very  slow  and  under  ordinary  circumstances 
does  not  cause  very  much  discomfort.  Aside  from  those 
of  a  syphilitic  nature  their  cause  is  usually  obscure.  When 
the  patches  are  small  they  should  be  left  absolutely  alone, 
as  the  usual  forms  of  treatment  recommended  cause  irri- 
tation, and  only  advance  them  toward  their  ultimate  end 
in  the  formation  of  epithelioma.  However,  if  they  are 
carefully  treated  with  radium  in  small  amounts  they 
rapidly  disappear.  Bayet  advocates  the  employment  of 
about  10  mg.  radium  element,  protected  by  a  thin  filter 
of  0.1  mm.  of  lead,  administered  in  one-hour  sittings  for 
about  six  hours. 

1  Munch,  med.  Woch.,  1904,  No.  31;  Exner,  Munch,  med.  Woch.,  1910. 
15 


226 


EP1THELIOMATA  AND  CARCINOMATA 


Carcinoma  of  the  mucous  membrane  of  the  buccal  cavity  or 
tongue  is  the  ultimate  end  of  leukoplakia.  Even  those  of  a 
syphilitic  nature  might  be  included  in  this  class.  When  once 
developed  as  carcinoma  the  prognosis  is  serious.  Even  under 


FIG.  55 


FIG.  56 


Recurrent  carcinoma  of  the  lip,  with 
involvement  of  cervical  glands. 


After  treatment.  Notice  the 
difference  between  the  gland  of 
the  neck;  radium  was  only  ap- 
plied over  lip. 


radiation  of  the  o>ray  or  where  radio-active  salts  are  used 
the  outlook  is  by  no  means  encouraging.    Pinch  reports  only 
10  cases  improved  out  of  a  total  of  60.     The  extension  is 
rapid,  as  early  metastasis  of  the  neck  is  not  unusual. 
Successful    cases    do   occur,    however,    and    have    been 


LEUKOPLAKIA 


227 


reported  by  many  authorities.  Exner1  reports  two  cases: 
one  a  man,  seventy-seven  years  of  age,  with  involve- 
ment of  the  right  side  of  the  mouth  and  extension  into 
the  antrum  and  nasal  cavities.  The  second  involved  the 
mucous  membrane  of  the  cheek,  from  the  lips  back  and 


FIG.  5; 


Illustration  showing  effects  of  radium  upon  a  carcinoma  of  the  lip  with 
extensive  infiltration.     Original  mass  was  about  the  size  of  an  apple. 


down  over  the  alveolar  process;  the  glands  of  the  neck 
were  also  enlarged.  The  neck  and  mouth  were  treated  for 
three  weeks;  during  this  time  six  radium  treatments  of 

1  Wien.  klin.  Woch.,  1903. 


228  EPITHELIOMATA   AND  CARCINOMATA 

fifteen  minutes  each  were  given,  which  resulted  in  com- 
plete subsidence  of  the  growth. 

The  following  case  will  be  of  interest: 

A  man,  aged  forty-seven  years;  German  workman, 
of  temperate  habits;  used  tobacco  moderately;  generally 
healthy;  denied  venereal  history;  usual  laboratory  test 
negative.  About  four  years  ago  he  developed  a  small  white 
spot  on  right  cheek,  which  extended  gradually.  A  short  time 
afterward  the  left  side  became  involved,  and  upon  this  side 
extension  was  somewhat  more  rapid.  At  the  time  of  exami- 
nation there  was  a  patch  upon  the  left  cheek  two  inches 
long  and  one  inch  wide,  the  bottom  of  which  was  ulcerated. 
The  deepest  part  seemed  to  extend  from  the  steno  duct  for- 
ward. On  the  right  side  there  was  a  patch  about  1^  inches 
long  and  one  inch  wide;  there  was  no  ulceration  on  this  side, 
nor  were  the  edges  so  well  defined.  While  this  was  the 
original  site  of  the  disease,  it  had  not  progressed  to  the  same 
extent  as  the  opposite  side.  He  had  previously  received 
x-ray  treatment,  evidently  with  no  effect.  Nineteen  treat- 
ments of  radium,  of  two-hour  sittings,  about  two  days  apart, 
were  given.  The  right  side  was  treated  first  until  it  cleared, 
then  the  opposite  side.  A  small  ulcerated  patch  remained 
on  the  right  side,  which  was  excised  and  healed  perfectly, 
and  since  then  he  has  had  no  further  trouble. 

Epithelioma  of  the  tongue  has  been  treated  by  Wickham 
and  Degrais1  with  0.04  gm.  radium  sulphate  filtered 
through  1  mm.  of  lead  properly  protected  from  secondary 
radiation.  The  applications  consisted  of  twenty-four  sit- 
tings of  two  hours  each.  Healing  resulted  with  a  fissure  at 
the  site  of  the  disease. 

1  Radium  Therapie,  Berlin,  1910. 


EPITHELIOMA   OF  THE  PALATE  229 

The  palate  is  frequently  the  seat  of  epitheliomatous  or 
careinomatous  disease,  which  usually  runs  an  extremely 
rapid  course,  causing  extensive  infiltration  of  the  fauces 
with  extension  to  the  glands  of  the  neck.  Loewenthal1 
refers  to  several  instances  which  have  been  benefited  by 
the  application  of  radio-active  salts. 

The  following  case  is  interesting  on  account  of  the  com- 
plete recovery  from  applications  of  an  extremely  small 
amount  of  radium. 

B.  Me.,  aged  fifty  years,  reported  for  treatment  April  18, 
1910,  at  the  American  Oncologic  Hospital.  He  had  an 
operation  upon  his  .throat  performed  at  one  of  the  larger 
hospitals  by  a  competent  surgeon.  This  had  been  followed  by 
Roentgen  radiation  administered  by  one  of  equal  distinction, 
but  the  disease  gradually  progressed.  Upon  consultation, 
another  surgeon  at  one  of  the  other  colleges  advised  a  radical 
operation,  which  the  patient  refused.  At  that  time  he  came 
under  observation.  The  disease  was  of  about  four  months' 
duration  and  had  progressed  rapidly.  His  general  and  family 
histories  were  negative.  To  exclude  any  chance  of  error 
he  was  put  upon  antisyphilitic  treatment,  with  no  result, 
although  a  Wassermann  test  proved  negative.  At  the  time 
treatment  began  there  was  a  nodular  ulceration  on  the 
left  side  of  the  soft  palate,  in  which  the  end  of  the  thumb 
could  be  inserted,  with  involvement  of  the  palatoglossal 
fold  extending  down  and  over  the  tongue.  The  alveolar 
process  of  the  superior  maxillary  bone  was  also  diseased 
and  necessitated  the  removal  of  three  teeth.  The  glands 
of  the  neck  were  palpable  on  the  same  side. 

The  amount  of  radium  used  in  this  instance  was  equal  to 

1  Grundriss  der  Radium  Therapie,  Wiesbaden. 


230  EPITHELIOMATA  AND  CARCINOMATA 

1  mg.;  it  was  contained  in  an  aluminium  capsule,  and  this 
in  turn  placed  in  a  thin  glass  tube  for  protection.  Treatments 
were  given  daily  for  one  hour,  and  the  patient  was  fairly 
regular  in  his  attendance,  which  continued  for  seven  months. 
After  the  first  seven  applications  he  had  much  relief  from 
pain  and  was  able  to  swallow  food  with  some  degree  of  com- 
fort. This  improvement  steadily  continued  until  the  whole 
process  in  the  mouth  had  healed,  when  the  glands  of  the 
neck  were  subsequently  excised.  Three  years  later  the 
man  was  in  good  health;  since  that  time  he  has  not  been 
seen. 

This  instance  shows  the  results  that  do  occasionally 
follow  the  use  of  small  amounts  of  radio-active  salts,  but 
under  ordinary  circumstances  it  would  be  safer  to  employ 
from  40  to  50  mg.  of  radium  element,  well  filtered,  applied 
both  without  and  within.  Under  this  treatment  the  more 
widespread  diseased  areas  are  likely  to  be  included. 

Fungoid  epithelioma  of  the  mouth  usually  occurs  near  or 
along  the  alveolar  process,  caused  by  the  ragged  ends 
of  teeth,  bone,  or  rough  plates  of  artificial  teeth.  As  a  rule, 
they  are  slow  in  growing  and  not  very  malignant;  they  are 
prone  to  recur  upon  being  removed  by  surgical  means. 
Microscopically  they  show  a  low-grade  epitheliomatous 
degeneration,  usually  of  a  typical  class.  (See  Fig.  60.) 

These  cases,  as  a  rule,  do  very  well  if  the  mass  is  removed 
and  the  base  radiated  thoroughly.  Under  this  procedure 
recurrence  is  not  likely,  provided  the  source  of  irritation 
has  been  removed.  The  following  history  illustrates  an 
instance : 

E.  R.,  aged  forty-eight  years,  developed  upon  the  mucous 
membrane  over  the  site  of  the  second  lateral  incisor  a 
small  mass  about  ^  inch  long  and  \  inch  wide,  having 


EPITHELIOMA   OF  THE  MOUTH 


231 


about  the  same  density  of  the  natural  gums,  also  the  same 
color,  and  showed  no  tendency  to  bleed  upon  manipulation. 


FIG.  58 


Epithelioma  before  treatment. 
FIG.  59 


Epithelioma  after  treatment. 


EPITHELIOMATA   AND  CARCINOMATA 


The  cause  was  supposed  to  be  due  to  the  friction  of  the 
plate  supporting  artificial  teeth.  The  mass  was  removed 
by  a  simple  cautery  knife,  after  the  injection  of  a  small 
amount  of  cocain,  and  no  bleeding  followed.  Four  treat- 
ments with  radium  were  given  to  the  base  over  the  site 
of  the  tumor. 

FIG.  60 


Microphotograph  of  the  epithelioma  from  section  of  tumor,  Fig.  58. 


Another  form  of  growth  in  this  locality  is  the  papilloma; 
they,  however,  have  more  the  appearance  of  a  wart  or  a 
number  of  warts.  Their  color  is  a  deeper  red  and  they 
usually  bleed  freely  upon  manipulation.  Microscopically 


CARCINOMA  OF  THE  TONGUE  233 

they  show  more  derangement  of  the  epithelium  and  may,  as 
a  rule,  be  regarded  as  being  slightly  more  malignant. 

Laryngeal  cancer  has  been  treated  with  radium  and  meso- 
thorium  with  a  fairly  good  average  of  success.  For  this 
form  of  disease  an  ideal  method  of  applying  the  radiation 
directly  to  the  parts  affected  is  by  introducing  a  small 
tube  containing  the  radio-active  salt  into  the  larynx,  and 
in  conjunction  giving  treatment  through  the  skin  externally 
from  all  sides.  Loewenthal1  has  reported  several  cases  of 
this  disease  successfully  treated. 

A  case  of  unusual  interest  has  been  reported  by  Worden,2 
where  the  primary  seat  of  disease  was  to  the  left  of  the 
epiglottis.  The  glands  of  the  neck  were  also  involved  and 
upon  section  it  proved  to  be  an  epithelioma.  As  much  of 
the  disease  as  possible  was  removed,  then  a  tube  of  40  mg. 
of  radium  bromide  was  applied  to  the  larynx  through  the 
wound,  and  four  applications  were  made  to  the  neck. 
About  nine  months  later  the  disease  recurred  and  radium 
treatment  was  again  instituted,  45  and  25  mg.  tubes  being 
used  upon  the  neck,  in  the  neighborhood  of  the  glottis. 
The  applications  were  followed  by  recovery  and  the  patient 
had  no  further  difficulty  two  years  after  the  last  recurrence. 

Carcinoma  of  the  tongue  is  usually  very  malignant,  both 
in  rapidity  of  ulceration  and  involvement  of  the  surrounding 
lymph  glands.  The  site  of  the  disease  is  usually  posterior 
and  to  either  side.  Here  again  the  exciting  cause  is  usually 
a  rough  tooth  or  like  process  causing  irritation.  The  patient 
when  seen  is  usually  far  advanced;  the  disease  is  so  wide- 
spread that  even  the  most  extensive  procedure  of  removing 
the  organ  with  all  glands  on  both  sides  of  the  neck  is  likely 

1  Grundriss  der  Radium  Therapie,  Wiesbaden. 

2  Brit.  Med.  Jour.,  October  25,  1913. 


234  EPITHELIOMATA  AND  CARCINOMATA 

to  be  followed  by  a  rapid  recurrence.  A  less  malignant  form 
following  upon  a  previous  condition  of  leukoplakia  usually 
occurs  upon  the  dorsum,  and  not  upon  the  sides.  This 
condition  presents  more  the  appearance  of  an  epithelioma. 
However,  when  the  stage  of  ulceration  has  been  reached 
the  extension  is  apt  to  be  rapid. 

Wickham  and  Degrais,1  Weidenfeld2  and  many  others 
have  reported  success  in  the  treatment  of  these  conditions 
with  the  use  of  radio-active  salts.  Carcinoma  involving 
the  deeper  tissues  in  or  near  the  parotid  gland  usually  grows 
in  the  form  of  a  tumor,  and  until  examined  microscopically 
is  thought  to  be  sarcomatous.  Ulceration  often  does  not 
occur  until  the  disease  has  well  advanced,  and  at  that 
time  extensive  neck  involvement  is  not  uncommon.  When 
removed  surgically,  recurrence  is  frequent;  but  on  account 
of  the  locality,  as  a  rule,  surgical  procedures  are  difficult 
and  dangerous,  and  it  is  necessary  under  these  conditions 
to  operate  very  early  in  the  disease,  and  widespread  dis- 
sections should  be  made.  Operations  in  late  cases  are 
hopeless;  in  these  cases  radiation  will  at  times  be  most 
beneficial.  In  the  list  of  56  cases  treated  by  Beckel,3  2 
cases  of  carcinoma  of  the  parotid  were  included  with  recovery 
of  1.  Pinch4  includes  7  cases  of  parotid  tumor  with  2 
apparently  cured  and  4  improved. 

Epithelioma  or  carcinoma  occurring  near  the  eye  usually 
extend  in  time  to  the  deeper  structures  of  the  orbit,  requir- 
ing excision  of  the  eyeball.  If,  however,  the  disease  has 
not  reached  this  stage,  thorough  radiation  should  be  admin- 
istered. Ordinarily  recovery  is  prompt  and  recurrence  is 

1  Radium,  Berlin.  2  Wien.  med.  Woch.,  1904. 

3  Moderne  Radium  und  Thor.,  etc.,  Berlin. 

4  Brit.  Med.  Jour.,  1913. 


EPITHELIOMATA  OF  THE  HAND  235 

not  usual.  If,  however,  the  disease  has  included  the  deep 
structure  of  the  orbit,  operation  for  removal  of  all  disease 
is  the  best  procedure  followed  by  thorough  radiation  to 
prevent  recurrence;  but  on  account  of  the  number  of  air 
cells  contained  in  and  about  the  orbit,  complete  removal 
of  disease  is  quite  impossible;  therefore,  in  all  cases  of 
malignancy  about  this  portion  of  the  head,  it  is  upon 
radiation  that  dependence  must  be  placed  for  its  complete 
eradication.  In  most  areas  about  the  face  superficial  radia- 
tion may  be  employed;  but  in  and  about  the  orbit  the 
radium  should  be  arranged  with  fairly  thick  filters;  otherwise 
the  deep  penetration  of  these  air  cells  will  be  lost.  Loewen- 
thal1  refers  to  a  deep  carcinoma  of  the  orbit  treated  with 
radium  filtered  by  1  mm.  lead;  three  applications  of  twenty- 
two  hours  were  made.  This  was  followed  by  complete 
recovery,  the  exophthalmos,  pain,  and  light  flashes  in  the 
eye  disappearing  with  improvement. 

Epitheliomata  of  the  hand  reported  by  Pinch.2  The  skin 
of  the  face  and  hands  was  deeply  freckled  and  had  several 
warty  growths  upon  it,  which  resembled  somewhat  xero- 
derma  pigmentosa.  Eighteen  months  previously  a  small 
tumor  was  removed  from  the  back  of  the  hand;  microscopic 
examination  proved  it  to  be  carcinomatous.  At  time  of 
treatment  there  was  an  ulcer  1.5  cm.  in  diameter  with  everted 
edges  and  indurated  base,  which  had  originated  at  the  end 
of  the  scar  of  a  previous  operation.  It  was  situated  over  the 
centre  of  the  middle  metacarpal  bone  of  the  right  hand,  and 
was  not  painful.  Radium  was  applied  for  fifty  minutes  with- 
out metal  screens;  a  sharp  reaction  followed  the  application 
which  resulted  in  complete  healing  of  the  ulcer.  The  same 

1  Gmndriss  der  Radium  Therapie,  Wiesbaden. 

2  Brit.  Med.  Jour.,  1913. 


236  EPITHELIOMATA   AND  CARCINOMATA 

author  reports  a  similar  case,  but  the  ulcer  was  somewhat 
larger  and  more  painful.  Seven  treatments  of  radium  one- 
half  the  strength  of  that  used  in  the  first  instance  were 
employed  without  a  screen.  Each  sitting  was  of  two  hours 
duration  and  one  month  apart.  The  full  strength  applicator 
contained  10  mg.  of  radium  to  the  square  centimeter. 

Epitheliomata  occurring  upon  the  hands  usually  follow 
a  condition  of  senile  keratosis  which  for  years  has  been 
subject  to  some  irritation;  often  occupations  where  the 
hands  are  continually  coming  in  contact  with  irritants, 
as  lime,  soot,  acid,  barbs  of  plants,  and  many  others.  In 
some  instances  its  origin  is  difficult  to  explain,  while  ex- 
posure to  cold  or  to  rays  of  the  sun  wrill  often  cause  it. 
Residents  of  rural  districts  seem  specially  prone  to  the 
development  of  this  condition.  When  the  spots  are  isolated 
and  not  too  extensive  they  yield  easily  to  a  few  mild 
applications;  but  where  the  vitality  is  low  or  the  local 
damage  great  from  previous  outbreaks  and  applications  of 
caustic  and  other  methods  calculated  to  produce  scar  tissue, 
the  prognosis  is  uncertain  even  where  radiation  has  been 
previously  employed. 

Burns  from  the  Roentgen  rays  have  been  healed  by  the 
application  of  radium  even  after-  they  reached  the  stage 
where  they  partook  of  the  character  of  an  epithelioma. 
The  application  under  these  circumstances  must  be  care- 
fully made  and  the  surrounding  parts  guarded  against 
irritation. 

Epitheliomata  developing  in  old  scar  tissue  are  not  uncom- 
mon, and  are  always  most  rebellious  to  treatment.  They 
are  slow  in  growth  and  very  indolent.  The  part  of  the 
scar  involved  is  usually  that  portion  which  seems  to  lack 
vitality.  Scars  that  have  existed  for  a  number  of  years  in 


CARCINOMA  237 

x 

a  perfectly  healthy  state  at  times  develop  a  form  of  epi- 
thelioma  that  from  general  appearance  and  rapidity  of 
growth  would  lead  one  to  suppose  they  were  sarcomatous. 
Histological  examination  under  these  circumstances  will 
prove  the  true  nature  of  the  condition.  They  are  also,  as 
a  rule,  unfavorable  cases.  Both  forms  are  particularly 
rebellious  to  treatment,  and,  when  healed,  show  a  constant 
tendency  to  break  dowrn.  This  is  particularly  noticeable 
in  extensive  scars  due  to  burns,  and  usually  those  that 
are  not  associated  with  keloids. 

Carcinoma. — The  treatment  of  carcinoma  developing  in 
the  glandular  structure  of  the  body  has  not  been  so  favor- 
able as  that  noticed  in  the  more  superficial  structures. 
Occasionally  decided  improvement  has  been  reported,  and 
no  doubt  as  the  technique  improves  and  the  cases  are 
selected  earlier  for  treatment  better  results  may  be  expected ; 
but  the  pathology  of  these  tumors  must  be  carefully  con- 
sidered and  some  method  adopted  for  checking  metastasis 
which  is  so  prone  to  occur.  In  a  list  of  7  cases  of  carcinoma 
of  the  stomach  only  2  were  improved;  while  in  another 
list  containing  5,  none  were  benefited.  In  one,  which  came 
under  observation  seven  years  ago,  and  submitted  to  an 
exploratory  incision,  carcinoma  of  the  pylorus  was  found. 
Roentgen  radiation  wras  applied,  with  complete  recovery, 
and  at  the  present  time  the  woman  is  still  in  good  health. 
Therefore  in  these  deep  cases  it  must  not  be  forgotten 
that  the  Roentgen  rays  will  at  times  yield  as  good  results 
as  these  radio-active  salts.  In  fact,  there  are  some  in- 
stances when  there  is  not  the  least  doubt  that  the  Roent- 
gen rays  wrould  be  the  method  of  election.  There  are  some 
who  prefer  to  use  both  forms  of  radiation  in  these  deep 
cases,  claiming  that  the  combination  of  the  two  yields 


238  EPITHELIOMATA  AND  CARCINOMATA 

| 

better  results  than  the  employment  of  one  alone.  At  the 
present  time  neither  form  of  radiation,  from  the  results  so 
far  presented,  can  be  considered  ideal. 

Gastric  Carcinoma. — In  a  case  treated  by  Gaultier  et  al.1 
where  the  tumor  at  the  pylorus  necessitated  a  gastro- 
enterostomy,  a  tube  containing  10  mg.  of  radium  sulphate, 
filtered  by  0.1  mm.  lead  was  passed  through  the  gastric- 
fistula;  later  this  amount  was  raised  to  50  mg.  of  radium 
sulphate  and  was  filtered  by  0.5  mm.  of  lead  foil.  Finally 
a  capsule  having  12  sq.  cm.  surface,  containing  120  mg. 
radium  sulphate,  was  employed  externally  and  was  fre- 
quently changed,  always  keeping  the  tumor  in  range. 
The  treatments  were  given  during  two  months;  eight, 
followed  by  two  in  three  weeks,  and  three  in  four  weeks. 
The  internal  treatments  were  of  two  hours'  duration  and 
the  external  ones  often  lasted  twenty-four  hours.  The 
fistula  healed,  tumor  disappeared,  and  the  patient  gained 
in  weight  from  120  pounds  to  157  pounds.  Czerny2  treated 
14  cases,  with  improvement  in  8;  in  all  he  combined  both 
the  radio-active  salts  with  Roentgen  radiation. 

Rectal  carcinoma  has  seemed  to  yield  somewhat  more 
regularly  to  the  influence  of  radiation,  and  various  lists 
show  a  far  better  proportion  of  improvements.  From  a 
series  of  43  cases,  1  was  apparently  cured  and  9  improved; 
while  in  another  series  of  7  cases  treated,  1  was  cured.  This 
may  be  due  to  the  different  methods  that  can  be  employed 
in  treating  these  rectal  cases,  for  it  is  often  possible  to  bring 
the  radium  in  direct  contact  with  the  disease.  The  peculiar 
anatomical  construction  of  the  parts  must  also  be  taken 


1  Lowenthal,  Grundriss  der  Radium  Therapie,  Wiesbaden. 

2  Beitr.  z.  klin.  Chir.,  1909. 


RECTAL  CARCINOMA  239 

into  consideration.  The  technique  adopted  by  Pinch  is  the 
employment  of  50  to  100  mg.  of  radium  screened  with  2  mm. 
of  lead  and  3  mm.  of  rubber.  The  capsule  is  introduced 
through  a  sigmoidoscope  and  is  held  in  position  by  a  wire 
of  silver,  which  is  soft  enough  to  be  bent  in  the  desired 
position  and  be  held  firmly  by  a  bandage.  Each  exposure 
is  from  six  to  twelve  hours'  duration,  and  is  repeated  daily 
until  thirty  to  sixty  hours'  exposure  has  been  given.  This 
series  is  then  repeated  in  about  six  weeks.  The  following 
cases  illustrate  its  application: 

M.,  aged  fifty-three  years.  For  several  years  suffered 
from  severe  rectal  hemorrhage  which  was  found  to  be  due 
to  a  craggy,  hard,  annular  mass;  lower  margin,  3  cm.  above 
anal  orifice,  while  upper  margin  was  9  cm.,  moderately 
fixed,  especially  posteriorly;  bled  freely  upon  examination. 
A  60  mg.  tube  of  radium  bromide  was  used,  screened  with 
2  mm.  of  lead,  and  applied  for  sixty  hours,  extending  over 
ten  days.  Six  weeks  later  the  growth  was  much  smaller, 
no  longer  ulcerated,  and  less  fixed  to  surrounding  tissue. 
At  this  time  the  patient  submitted  to  a  Kraske's  operation, 
followed  by  a  course  of  prophylactic  irradiation  with  the 
same  amount  of  radium,  with  the  same  screen,  for  thirty 
hours.  The  patient  regained  perfect  health. 

Mrs.  F.,  aged  fifty-six  years,  had  an  indefinite  history  of 
abdominal  pain  and  obstinate  constipation  which  was  found 
to  be  due  to  a  hard,  annular  growth  about  the  bowel  16 
cm.  above  the  anus.  It  was  slightly  ulcerated  anteriorly 
and  bled  upon  examination;  the  surrounding  tissues  were 
invaded.  The  lumen  of  the  bowel  was  very  small  and 
irregular,  about  the  size  of  a  crow's  quill;  an  offensive 
discharge  was  continuously  present  and  in  consequence 
the  patient  was  weak  and  emaciated.  A  tube  containing 


240  EP1THELIOMATA   AND  CARC1NOMATA 

the  emanation  of  radium  with  the  initial  activity  of  83 
ing.,  screened  with  1.5  mm.  of  lead  was  placed  in  the  lumen 
of  the  growth  and  left  for  twenty-four  hours.  Six  weeks 
later  a  severe  reaction  was  reported,  but  afterward  improve- 
ment followed,  discharge  ceased  to  be  offensive  and  pain 
was  only  slight;  the  lumen  of  the  bowel  was  much  larger  and 
ulceration  disappeared.  Two  months  later  another  tube 
of  emanation  with  the  initial  activity  of  63.2  mg.,  guarded 
by  a  screen  of  2  mm.,  was  placed  in  the  bowel  for  another 
exposure  of  twenty -four  hours;  but  no  reaction  is  mentioned 
as  following  this  application,  and  since  that  time  the  patient 
has  been  about  the  house  attending  to  her  usual  duties  and 
is  in  perfect  health.  Other  cases  equally  interesting  are 
mentioned. 

Carcinoma  occurring  in  the  intestinal  and  colonic  portion 
of  the  bowel  seems  to  bear  about  the  same  relation  in  regard 
to  the  cause  and  treatment  with  radio-active  salts  as  that 
occurring  in  the  stomach.  The  difficulty  of  recognizing  and 
locating  the  mass  until  too  late,  when  the  process  has  become 
widely  disseminated,  is  even  more  likely  to  happen,  due  to 
the  obscure  symptoms  they  present. 

Carcinoma  of  the  liver  or  gall-bladder  does  not  seem  to  be 
benefited  by  the  application  of  radiation  in  any  form, 
and  most  of  the  cases  reported  offer  very  little  hope  of  being 
benefited.  There  seems  to  be  a  degree  of  malignancy  in 
these  conditions  that  radiation  fails  to  control.  This  is 
also  true  of  malignant  disease  of  the  deeper  glandular 
structures  such  as  the  pancreas,  and,  to  some  extent, 
primary  disease  occurring  in  the  glands  of  the  chest.  How- 
ever, most  carcinomas  occurring  within  the  chest  cavity  are 
secondary;  and  when  recognized  the  person's  general  state 
of  health  has  been  so  far  dissipated  that  treatment  is  of 


CARCINOMA  OF  THE  BREAST  241 

little  avail,  due  to  lowered  vitality.  However,  where  the 
progress  of  the  disease  is  not  too  rapid,  and  the  patient  is 
able  to  endure  fairly  vigorous  treatment,  satisfactory  results 
may  be  expected. 

Carcinoma  of  the  breast  is  a  condition  that  must  be  con- 
sidered from  several  stand-points  before  a  prognosis  of  the 
individual  case  can  be  given.  This  tumor  is  one  of  the 
commonest  seen  by  the  radiologist;  it  occurs  at  all  ages, 
and  malignancy  varies  in  a  wide  degree.  Fulminating 
forms  are  seen  where  the  process  from  the  time  it  starts 
until  death  occurs  is  less  than  a  year,  and  at  the  present 
we  have  no  remedy  that  for  one  instant  stays  its  pace.  On 
the  other  hand,  within  one  week  two  women  presented 
themselves  for  treatment,  one  with  the  history  of  the  dis- 
ease of  fourteen  years'  standing.  Her  age  was  sixty-seven, 
and  at  that  time  the  involvement  included  her  left  breast: 
The  tumor  was  about  as  large  as  a  child's  fist,  with  the  whole 
upper  surface  ulcerated;  glands  involved  the  axilla  and  the 
neck,  possibly  from  pus  and  not  from  actual  malignant 
disease.  Her  general  condition  was  excellent  and  there 
was  no  sign  of  cachexia.  The  condition  healed,  yielding 
easily  to  the  influence  of  radiation,  the  Roentgen  rays 
being  employed.  The  second  case  was  of  about  the  same 
age,  with  the  disease  extending  over  both  breasts;  ulcera- 
tion  quite  extensive  on  the  left  side  about  the  size  of 
one's  hand,  while  on  the  right  side  it  was  somewhat  less. 
The  process  was  of  nine  years'  duration.  This  woman 
was  also  treated  by  the  Roentgen  rays;  but,  living  at  a 
distance,  she  concluded  the  annoyance  from  the  ulceration 
did  not  warrant  the  inconvenience  experienced  in  making 
the  journey  for  the  treatments,  consequently  they  were 
discontinued. 
16 


242  EPITHELIOMATA   AND  CARCINOMATA 

The  point  of  interest  in  both  these  cases  is  the  indolent 
character  of  the  disease,  which  no  doubt  could  have  been 
controlled  by  any  of  the  more  conservative  forms  of  treat- 
ment if  adopted  in  the  early  stages;  therefore  deduction  in 
all  these  numerous  methods  recommended  for  the  control  of 
malignancy  must  be  guarded  with  the  utmost  conserva- 
tism. 

Paget's  disease  of  the  nipple,  a  condition  of  eczema,  is 
usually  the  forerunner  of  malignancy.  The  exact  relation  is 
not  definitely  understood,  but  where  it  cannot  be  controlled 
without  recurrence,  early  operation  by  complete  removal 
of  breast  and  all  surrounding  glands  is  to  be  recommended. 
The  actual  condition  is  one  that  usually  heals  easily,  both 
after  radium  and  Roentgen  radiation;  however,  cases  have 
been  known  to  be  completely  healed,  and  a  few  years  later 
to  have  developed  a  mass  in  the  tissues  of  the  breast.  While 
many  have  been  permanently  relieved,  this  unfortunate 
sequellse  must  be  constantly  borne  in  mind.  From  the 
stand-point  of  radiology  this  disease  might  be  compared  with 
the  superficial  epithelioma  which  appears  in  all  parts  of  the 
body,  but  has  the  one  difference  that  the  usual  underlying 
condition  resembles  more  an  eczema  than  the  dry,  scaly, 
wart-like  conditions  usual  to  those  upon  the  face  or  hands. 
There  has  been  a  report  of  several  cases  of  Paget's  disease 
occurring  about  the  umbilicus,  but  whether  this  condition 
can  properly  be  included  in  this  class  is  questionable,  as  the 
lack  of  glandular  tissue,  either  resembling  or  analogous  to 
that  of  the  breast,  is  not  found  in  the  neighborhood  of  the 
umbilicus.  While  the  actual  conditions  may  closely  resemble 
each  other  the  subsequent  course  must  necessarily  differ; 
therefore,  in  making  comparison  of  these  cases  they  must 
not  be  included  with  those  that  occur  about  the  nipple. 


PRIMARY  CASES  OF  CARCINOMA  OF  THE  BREAST     243 

Primary  cases  of  carcinoma  of  the  breast  without  extensive 
involvement  should  submit  promptly  to  operation,  and  from 
our  present  knowledge  this  course  offers  the  best  hope 
of  ultimate  "cure;"  delay  under  any  circumstances  is 
not  justifiable.  The  position  of  the  tumor  at  the  time  of 
development  seems  to  influence  to  some  extent  the  chances 
of  metastasis;  the  inner  two  quadrants  being  much  more 
liable  to  cause  lymphatic  infection  of  the  mediastinal 
gland,  while  the  two  outer  quadrants  infect  the  axilla 
where  there  is  more  likelihood  of  removing  them  by 
thorough  resection.  When  the  axillary  glands  are  infected 
recurrence  is  likely  to  be  observed  early,  and,  if  the  cervical 
glands  are  enlarged  at  the  time  of  operation,  statistics  show 
that  only  3  per  cent,  of  these  individuals  pass  the  three- 
year  limit  after  operation. 

Radiation  previous  to  operation  has  been  recommended, 
and  if  employed  it  should  in  no  manner  be  allowed  to 
interfere  with  the  operation,  for  the  results  of  such  a  pro- 
cedure are  still  sub  judice.  Radiation  at  the  time  of  the 
operation  in  the  open  wound  can  do  no  harm,  but  just 
what  advantage  it  will  be  to  the  individual  is  difficult  to 
foresee.  The  employment  of  deep  radiation  under  these  cir- 
cumstances can  hardly  be  explained,  for  it  would  seem  that 
if  the  rays  used  are  to  be  penetrating  and  all  kinds  of  metal 
filters  interposed,  a  few  inches  of  tissue  would  not  obstruct 
many  of  these  high  rays.  Postoperative  radiation  should 
be  adopted  in  all  cases  of  cancer;  it  will  no  doubt  lessen  the 
chance  of  recurrence,  for  if  it  is  possible  to  heal  cases  when 
they  have  decided  evidences  of  disease,  certainly  the  chances 
are  better  before  it  has  gained  headway  to  that  extent. 
If  the  disease  reappears  after  operation  in  the  form  of 
scattered  nodules  in  or  near  the  site  of  the  original,  a 


244  EP1THEL1OMATA  AND  CARCINOMATA 

second  operation  is  not  justifiable  except  for  comfort;  for 
it  is  likely  that  other  processes  exist,  hidden,  which  cannot 
be  removed  and  in  these  cases  radiation  should  be  pushed. 
The  disease  should  not  be  allowed  to  progress  to  the  extent 
of  ulceration  or  deep  glandular  involvement  before  radia- 
tion is  employed.  Very  few  of  these  late  cases  recover, 
for  even  though  the  local  condition  be  benefited  the  wide 
dissemination  of  the  disease  causes  it  to  break  out  in  other 
organs  of  the  body. 

Radiation  of  the  primary  case  is  a  most  difficult  question. 
If  a  person  refuses  operation,  is  it  justifiable  to  employ  the 
o>rays  or  radio-active  salts?  Then,  too,  if  this  case  is  treated 
and  the  tumor  disappears,  the  question  is  still  asked,  "What 
was  the  tumor?"  From  a  diagnostic  stand-point  it  is 
extremely  dangerous;  from  a  moral  stand-point  it  is  bad; 
for  in  the  event  of  a  recovery  from  some  simple,  benign 
growth  that  may  degenerate  under  the  influence  of  radiation 
others  with  a  more  fatal  disease  may  take  the  same  stand, 
thinking  that  to  avoid  operation  would  insure  an  easy  road 
to  recovery,  and  thereby  not  discover  the  error  until  too 
late,  the  metastatic  processes  having  been  sent  broadcast 
over  the  entire  system. 

The  usual  case  that  is  presented  for  treatment  is  where 
well-marked  recurrence  has  been  established;  the  superficial 
involvement  may  be  slight,  only  a  few  scattered  patches  of 
the  disease.  Usually  the  axilla  is  bound  down  with  scar 
tissue  and  a  few  glands  in  the  neck  may  be  evident.  The 
mediastinal  glands  are,  as  a  rule,  involved,  the  patient 
having  the  short,  hacking,  dry  cough,  accompanied  by  some 
shortness  of  breath;  yet,  as  formerly  stated,  the  superficial 
involvement  gives  very  little  evidence  of  the  actual  amount 
of  disease.  Many  such  cases  have  been  restored  to  health, 


EPITHELJOMA  OF  THE  BREAST        245 

but  of  the  number  presented  comparatively  few.  It  would 
be  natural  to  suppose  that  the  prognosis  in  these  cases 
would  be  in  relation  to  the  amount  of  involvement.  This, 
however,  is  not  always  a  safe  guide  for  many  late  cases  will 
respond  to  treatment. 

Neglected  cases  of  carcinoma  of  the  breast  frequently 
come  under  observation  where  the  amount  of  tissue  involve- 
ment precludes  operation.  The  breast  is  bound  down  to  the 
underlying  tissue,  and  the  gland  of  the  axilla  and  neck  are 
involved,  therefore  it  would  be  natural  to  suppose  the 
mediastinal  glands  were  in  the  same  condition,  depending 
somewhat  upon  the  situation  of  the  primary  growth.  By 
careful  application  of  the  x-ray  or  radium  it  is  possible  to 
produce  a  retrograde  change  that  will  in  some  instances  cause 
the  local  disease  to  become  absorbed  and  make  it  possible 
for  a  thorough  operative  procedure.  In  several  instances 
that  have  come  under  observation  the  patients  were  restored 
to  perfect  health. 

Epithelioma  of  the  breast  frequently  occurs  and  differs 
from  the  deep  glandular  type  of  disease  in  that  usually  the 
process  begins  from  without  and  extends  inward.  These 
cases  are,  as  a  rule,  much  more  favorable  for  radiation  than 
the  adenomatous  type. 

The  x-ray  is  the  form  of  radiation  that  is  most  desirable 
in  these  cases  of  breast  cancer,  but  it  must  not  be  for- 
gotten that  the  radiation  from  these  radio-active  salts  may 
in  certain  individuals  be  more  acceptable,  due  to  some 
personal  idiosyncrasy.  Where  one  form  of  radiation  does 
not  seem  to  benefit  a  given  individual  there  is  no  reason  to 
suppose  that  another  form  will  not  relieve  the  condition. 
From  a  series  of  89  cases  of  carcinoma  of  the  breast  treated 
at  the  London  Radium  Institute  1  was  apparently  cured  and 


246  EPITHELIOMATA   AND  CARCINOMATA 

34  improved.  In  the  treatment  of  these  cases  as  much  as 
230  mg.  of  radium  bromide  was  used  for  thirty  to  forty 
hours,  given  in  a  number  of  sittings.  The  form  of  disease 
that  was  usually  benefited  was  the  sclerotic  type,  while 
the  encephaloid  type  was,  as  a  rule,  simply  relieved. 

Carcinoma  of  the  thyroid  has  been  reported  by  Pinch.1 
One  case  was  apparently  cured,  while  the  other  improved. 
The  first  case  was  a  woman,  aged  thirty-five  years.  About 
six  months  previous  to  treatment  she  developed  cough, 
dysphagia,  and  dyspnea,  with  an  occasional  slight  hemor- 
rhage; these  symptoms  were  increased  by  excitement. 
When  she  reported,  the  disease  was  past  operative  inter- 
ference, and  a  radiograph  showed  pulmonary  involvement. 
120  mg.  of  radium  bromide  was  applied,  screened  with  2  mm. 
of  lead.  Applications  were  made  for  six  hours  the  first  four 
days.  About  one  month  afterwrard  a  second  application 
of  six  hours,  for  five  days,  was  performed,  followed  by  a 
third  application  the  following  month  for  the  same  time. 
About  three  months  later  the  tumor  had  disappeared  as 
well  as  the  concomitant  symptoms,  and  the  patient  was 
able  to  pursue  her  vocation  as  a  school-mistress. 

i  Brit,  Med.  Jour.,  1913. 


CHAPTER   XVII. 
APPLICATION  IX  SARCOMATA. 

General  Considerations  of  Sarcoma — Diseases  of  Bones  and  Joints- 
Head — Glioma — Lymphosarcoma — Lymphadenoma — Mycosis  Fungoides — 
Idiopathic  Hemorrhagic  Sarcoma — Sarcoma  of  the  Sternum. 

OF  all  the  malignant  tumors,  sarcoma  is  the  most  irregular 
in  its  course.  The  clinical  history  of  the  case  may  aid  to 
some  extent  in  the  prognosis,  but  so  far  as  the  histological 
appearance  is  concerned,  practically  no  exact  deductions 
are  possible.  Often  cases  are  observed  where  the  micro- 
scope shows  a  small  round-cell  sarcoma,  or  even  at  times 
one  of  the  distinct  melanotic  varieties  that  should  under 
normal  circumstances  be  extremely  rapid  in  growth,  and  ex- 
tending by  rapid  metastasis  which  will  not  follow  the  usual 
course  but  develop  in  such  a  slow  manner  as  to  give  not 
the  least  suspicion  of  its  actual  significance.  On  the  other 
hand,  the  slow-growing  giant-cell  sarcoma  may  become 
extremely  rapid  and  develop  in  such  a  short  space  of  time 
that  one  would  place  it  among  the  most  malignant  diseases. 
Metastasis  in  sarcoma  may  be  observed  in  its  most  unex- 
pected parts.  This  often  gives  rise  to  considerable  embar- 
rassment. While  the  local  growth  may  respond  to  treatment 
in  the  most  orderly  manner,  the  extensions  to  distant  points 
may  occur  rapidly  and  be  widespread,  thus  making  many 
applications  most  difficult  and  more  unfortunate  from  the 
fact  that,  if  not  upon  the  surface  of  the  body,  they  are  likely 


248  APPLICATION  IN  SARCOMATA 

to  be  overlooked  until  their  development  reaches  such  an 
extent  that  constitutional  infection  causes  a  lowering  of 
vital  forces. 

Spectacular  results  more  often  occur  with  sarcomatous 
tumors  than  any  other  class.  These  are  not  alone  confined 
to  radium  or  the  other  forms  of  radio-active  elements, 
but  occur  also  from  radiation  of  the  Roentgen  rays.  In 
fact,  numbers  of  instances  are  on  record  of  spontaneous 
disappearance,  from  no  assignable  cause;  therefore,  in  the 
treatment  of  these  sarcomas  the  actual  results  must  not 
always  be  ascribed  to  the  efficiency  of  the  method.  It  is 
not  unusual  for  a  sarcoma  to  start  rapidly  and  progress 
to  a  fair-sized  tumor,  then  become  quiescent  and  remain 
in  that  condition  for  years,  even  during  that  time  under- 
going a  retrograde  change;  then,  without  the  least  warning, 
to  take  on  another  spontaneous  growth  until  it  results  in 
a  fatal  issue.  As  a  rule,  however,  sarcomas  yield  readily 
to  radiation.  Large  growths  are  prone  to  undergo  a  very 
rapid  degeneration,  and  if  the  person  is  debilitated  the 
resultant  toxemia  is  often  severe,  if  not  fatal. 

Most  sarcomata  develop  in  the  deeper  tissue;  therefore 
the  radiation  demanded  under  these  conditions  must  be  a 
large  amount  of  high  penetrating  rays,  with  all  low  rays 
and  secondary  radiation  carefully  eliminated  by  proper 
filtration.  These  cases,  as  a  rule,  also  respond  promptly  to 
the  use  of  the  Roentgen  rays;  therefore  it  must  not  be 
concluded  that  the  radiation  from  these  radio-active  elements 
alone  controls  this  disease.  While  results  are  equally  brilliant 
and  startling,  the  general  rule  must  not  be  forgotten  that 
there  are  cases  of  sarcoma  as  well  as  other  tumors  that  will 
respond  better  to  a  certain  form  of  radiation.  This  can 
only  be  determined  by  the  actual  application. 


APPLICATION  IN  SARCOMATA  249 

A  class  of  sarcomas  occurring  in  the  lung  with  an  exceed- 
ingly rapid  course  is  not  benefited  by  any  form  of  radiation. 
These  cases  are  rarely  diagnosed  correctly  until  a  postmor- 
tem examination  has  been  made.  Some  are  so  rapid  that 
they  closely  resemble  pneumonia  both  from  their  signs  and 
symptoms,  except  the  febrile  reaction  is  never  so  high,  and 
the  pulse  usually  is  less  bounding.  The  usual  case,  however, 
runs  a  course  of  from  three  weeks  to  three  months.  Sarcoma 
of  the  lung  is  rarely  primary,  but  usually  follows  as  a  sec- 
ondary infiltration  from  some  distant  portions  of  the  body. 
These  processes  are,  as  a  rule,  slower  in  their  course,  but 
when  the  patient  reaches  the  stage  of  pulmonary  invasion 
his  general  system  has  been  greatly  depleted,  and  treatment 
of  the  local  conditions  is  not  to  be  considered.  The  liver  is 
the  frequent  seat  of  secondary  involvement  from  sarcoma, 
and  the  tumor  develops  to  such  a  degree  before  it  is  recog- 
nized that  treatment  usually  has  but  little  influence  upon 
its  course. 

The  small,  isolated  sarcoma  may  be  considered  as  a  most 
favorable  tumor  for  radiation,  provided  there  is  no  metas- 
tasis, and  even  masses  of  considerable  size  yield  easily  and 
promptly.  The  following  cases  of  widely  different  natures 
illustrate  these  facts: 

Mr.  F.  F.,  aged  thirty-one  years;  Hungarian.  History 
was  obtained  with  considerable  difficulty.  Tumor  of  the  left 
eye  began  several  years  ago,  and  on  account  of  the  pain 
and  swelling  he  finally  submitted  to  operation.  About  ten 
weeks  before  he  came  under  observation  the  eyeball  was 
removed  and  the  tumor  dissected  out  as  well  as  possible; 
but  as  it  had  penetrated  the  antrum  and  the  nasal  cavities 
complete  operation  was  impossible.  Histological  diagnosis 
was  a  fibrosarcoma.  Recurrence  was  extremely  rapid 


250  APPLICATION  IN  SARCOMATA 

after  the  operation,  with  return  of  pain  and  eye  symptoms 
upon  the  opposite  side.  More  extensive  operation  was 
regarded  as  useless  and  he  was  referred  for  radium  treat- 
ment. He  was  given  twelve  treatments  of  two  hours  each 
with  11  mg.  of  radium  element,  protected  by  0.5  mm. 
aluminium  and  0.2  mm.  of  lead,  applied  in  different  posi- 
tions, and  from  these  treatments  the  mass  disappeared  and 
the  subjective  symptoms  subsided. 

Bones  are  frequently  the  seat  of  sarcomatous  tumors, 
and  while  at  times  they  yield  readily  to  the  Roentgen  rays 
many  are  rebellious,  and  in  such  instances  radium  or  meso- 
thorium  wTill  be  found  to  be  of  value.  Abbe1  reports  a  case 
of  giant-cell  sarcoma  of  the  jaw,  with  submaxillary  involve- 
ment. The  bone  was  softened  and  the  tumor  was  about 
the  size  of  a  walnut.  A  few  applications  were  made  by 
applying  the  tube  of  radium  to  the  gums,  and  later  it  was 
imbedded  directly  in  the  tumor;  about  fifteen  applications 
being  given  in  this  manner.  The  mass  gradually  shrank, 
ossification  began,  and  in  about  three  months  the  condition 
of  the  bone  was  practically  normal. 

Sarcoma  occurring  within  the  auditory  canal  has  been 
reported  by  Finzi.2  A  boy,  aged  eight  years,  had  a  small 
polypus  protruding  from  the  external  auditory  meatus,  ac- 
companied with  more  or  less  free  discharge  of  pus.  Removal 
was  promptly  followed  by  recurrence,  and  the  hystological 
examination  showed  it  to  be  an  endothelial  sarcoma.  After 
the  second  removal  Coley's  fluid  was  administered  with  no 
relief,  and  when  the  child  came  under  Dr.  Finzi's  care  there 
was  a  large,  bluish,  fungating  mass  extending  behind  the 
ear,  1|  inches  in  diameter,  also  a  mass  from  the  external 

1  Med.  Record,  1904. 

2  Clin.  Sect.  Proc.  of  the  Royal  Soc.  Med.,  1910. 


GLIOMA 


251 


auditory  meatus  which  discharged  freely.  Glands  below 
the  ear  were  also  involved,  under  the  sternocleidomastoid 
muscle  as  well  as  a  few  in  the  posterior  triangle.  Treatment 
was  given  as  follows: 


Thickness  in  millimeters. 


itacnum  ; 

Date  of 

milligrams 

Silver 

Platinum 

Lead 

Rubber 

Time  and 

treatment. 

of  bromide. 

filter. 

filter. 

filter. 

cover. 

position. 

Feb.       21. 

50 

0.5 

12  }  hrs.;  glands. 

17 

1 

1 

1 

15 

hrs.;  on  meatus. 

Feb.       22. 

50 

0.5 

1 

1 

18 

hrs.  ;  behind  ear. 

17 

1 

1 

1 

44 

hrs.;  in  meatus. 

March  30. 

17 

1 

1 

1 

10 

hrs.  ;  lowest  glands. 

50 

0.5 

1 

2 

13 

hrs.;  middle  glands. 

March  31. 

50 

0.5 

1 

21 

hrs.;  behind  ear. 

50 

0.5 

1 

8 

hrs.;  apex    of    pos- 

terior triangle. 

The  tumor  had  subsided  and  its  condition  was  greatly 
improved  when  the  patient  was  presented  to  the  Society. 
A  fairly  good  idea  of  the  technique  used  is  presented  by 
this  table. 

Glioma  occurring  in  the  posterior  portion  of  the  skull, 
between  the  cerebrum  and  cerebellum  on  the  left  side,  in 
a  young  man  aged  eighteen  years,  was  removed  by  surgi- 
.cal  procedure,  and  from  all  signs  and  symptoms  promptly 
recurred.  A  second  operation  wTas  performed  about  fifteen 
months  later,  and  as  much  of  the  tumor  as  was  possible 
again  removed.  This  second  operation  did  not,  however, 
relieve  the  symptoms,  which  were  headache  and  unsteady 
gait  in  walking;  more  or  less  pain  associated  with  the  back 
of  the  head  over  the  site  of  the  scar.  These  annoying 
symptoms  began  about  a  year  before  the  first  operation. 
His  previous  health  had  been  good ;  family  history  negative, 


252  APPLICATION  IN  SARCOMATA 

and  at  the  time  of  observation  was  well  nourished.  Applica- 
tions of  radium,  filtered  through  2  mm.  of  lead  protected 
by  about  one  inch  of  cotton,  were  made  in  the  neighbor- 
hood of  the  operative  scar  in  different  positions,  three  times 
a  week,  and  continued  for  four  months;  11  mg.  radium 
element  was  used  and  each  application  lasted  from  four  to 
six  hours.  The  hair  over  the  site  had  been  removed,  but 
only  slight  dermatitis  was  produced.  The  headaches  have 
been  dissipated  and  the  normal  gait  restored.  (See  Fig.  48.) 

A  sarcoma  of  the  neck  treated  with  radium  with  recurrence 
in  the  mediastinum  was  reported  by  Finzi  and  Hill.1  In  the 
treatment  of  the  portion  that  involved  the  esophagus  they 
used  50  mg.  of  French  radium  bromide  and  63  mg.  of  German 
radium  bromide  in  a  small  tube  with  f  mm.  of  silver  for 
a  filter.  The  whole  capsule  measured  9  mm.  in  diameter, 
and  this  was  lowered  into  the  esophagus  to  the  constricted 
portion,  where  it  was  held  from  two  to  four  hours.  About 
the  same  technique  was  used  in  the  treatment  of  the  local 
condition  in  the  neck  as  was  employed  in  previous  cases, 
except  occasionally  from  eight  to  twelve  layers  of  lint  was 
substituted  for  the  rubber  protection. 

Melanotic  sarcoma  has  been  treated  by  Czerny,  Exner, 
Blauel,  and  Dominici2  in  a  number  of  instances  with  success. 
In  several  cases  more  than  one  hundred  small  nodules  existed, 
scattered  over  the  whole  body. 

A  method  advised  by  Pinch  in  the  treatment  of  sarcomata 
is  to  insert  a  tube  of  radium  or  radium  emanation  into  the 
centre  of  the  growth  and  leave  it  in  position  for  twenty 
to  thirty  hours,  and  then  repeat  in  about  one  month; 
50  to  100  mg.  of  radium  or  its  equivalent  being  used  with 

1  Loc.  cit. 

2  Grundriss  der  Radium  Therapie,  Lowenthal,  Wiesbaden. 


SARCOMA  OF  THE  THIGH  253 

each  application,  and  screened  with  0.5  to  1  mm.  of  silver. 
Under  this  method  the  sarcomatous  mass  usually  undergoes 
a  retrograde  change,  leaving  only  a  small  nodule  of  fibrous 
tissue  which,  as  a  rule,  gives  no  further  trouble.  Where 
this  procedure  is  impractical  the  usual  "cross-fire"  method 
is  employed  as  a  substitute,  about  the  same  amount  of 
radium  being  employed,  and  a  screen  of  1  to  2  mm.  of 
lead  substituted  for  the  silver.  The  following  cases  illustrate 
these  methods: 

Sarcoma  of  superior  maxilla  occurring  in  a  man,  aged 
seventy-two  years.  The  growth  was  of  about  three  months' 
duration,  and  extended  over  the  left  half  of  the  hard  palate 
into  the  left  nostril,  pushing  the  central  wall  over  against 
the  nasal  septum  and  causing  epiphora  and  diplopia.  An 
emanation  tube  of  initial  activity  of  44.5  mg.  radium, 
screened  with  1  mm.  of  lead,  was  inserted  into  the  growth 
and  left  there  for  twrenty-four  hours.  Histological  exami- 
nation proved  the  growth  to  be  a  round-celled  sarcoma. 
About  two  months  later  there  was  considerable  improve- 
ment in  the  growth.  Eye  symptoms  had  disappeared  and 
at  that  time  another  tube  of  emanation,  equal  to  30  mg. 
radium  at  its  initial  activity,  protected  by  1  mm.  of  lead, 
was  inserted  into  the  growth.  Complete  recovery  followed. 

Sarcoma  of  the  thigh  occurring  in  a  lad,  aged  eighteen  years, 
directly  following  an  injury.  The  tumor  had  poorly  defined 
edges,  was  slightly  tender,  and  was  situated  at  the  junc- 
tion of  the  middle  and  lower  third.  It  was  thought  to 
be  a  periosteal  sarcoma,  but  histological  diagnosis  proved 
it  to  be  a  spindle-celled  sarcoma.  A  tube  of  emanation 
equivalent  to  100  mg.  of  radium  bromide,  protected  by  1  mm. 
of  lead,  was  embedded  in  the  tumor  and  left  for  twenty- 
four  hours.  Seven  weeks  later  another  tube,  equivalent 


254  APPLICATION  IN  SARCOMATA 

to  75  mg.  radium,  protected  by  1  mm.  lead  screen,  was 
inserted.  The  tumor  decreased  in  size  and  the  patient 
was  able  to  walk  with  ease,  and  there  has  been  no  sign  of 
dissemination. 

Deep  sarcomas  occurring  in  the  thigh  show  a  somewhat 
greater  tendency  to  give  rise  to  metastasis  than  those  in 
other  localities.  The  usual  site  of  recurrence  is  in  the 
lungs. 

Lymphosarcoma  of  the  neck  has  also  been  reported  by 
Pinch.1  The  patient  had  submitted  to  two  operations  with 
recurrence  in  a  short  space  of  time  after  each.  When  placed 
under  treatment,  the  growth  measured  6.5  x  4  x  1.3  cm.; 
was  hard  and  firmly  fixed  to  the  underlying  tissue,  and 
was  situated  behind  the  jaw  and  below  the  ear.  The  skin 
over  the  growth  was  glazed  and  hyperemic;  considerable 
pain  was  also  experienced.  Fourteen  treatments  of  200 
mg.  of  radium,  screened  by  2  mm.  of  lead,  were  given  from 
the  effects  of  which  the  growth  entirely  disappeared. 

Lymphadenoma  (Hodgkin's  disease)  has  been  successfully 
treated  by  radiation ;  but  the  widespread  character  of  the  dis- 
ease makes  recurrence  extremely  probable.  Czerny2  reports 
a  series  of  8  cases  treated  by  radium.  In  all  the  glands 
disappeared,  which  was  accompanied  by  general  improve- 
ment. They  were  all  treated  by  injection  of  radium  emana- 
tion in  water;  the  amount  varied  from  28  cc.  to  130  cc.; 
some  of  them  also  received  more  or  less  radiation  from 
the  Roentgen  rays. 

Mycosis  fungoides  is  a  form  of  sarcoma  appearing  upon 
the  skin  which  is  usually  very  widespread  and  is  slow  in 
its  course.  This  disease  has  been  treated  by  the  Roentgen 

1  British  Mod.  Jour.,  1913. 

2  Grundriss  der  Radium  Therapie,  Wiesbaden. 


SARCOMA   OF  THE  STERNUM 


255 


rays  and  also  by  radium,  and  Bayet1  concludes  that  the 
latter  is  much  more  efficient,  causing  a  disappearance  of 
the  nodules  in  a  shorter  space  of  time  with  less  scarring; 
the  actual  amount  of  radiation  can  also  be  observed.  The 
filter  employed  in  these  cases  was  1  mm.  thick. 

FIG.  61 


Burn  following  application  of  radium  to  a  sarcoma  of  the  sternum  that 
had  been  previously  treated  by  the  Roentgen  rays. 

Idiopathic  hemorrhagic  sarcoma  of  Kaposi,  a  rare  condition 
of  sarcoma  usually  following  some  long-standing  irritation 
of  the  skin,  such  as  a  chronic  eczema  or  epithelioma.  Treat- 
ment of  this  rare  condition  with  radium  has  been  reported. 

Sarcoma  of  the  sternum,  a  mass  about  the  size  of  a  small 
apple,  appeared  over  the  upper  end  of  the  sternum,  filling 
the  suprasternal  notch.  It  followed  a  blow  upon  that  region 
from  an  accident.  Two  attempts  were,  made  at  different 

1  Das  Radium,  Wien. 


256  APPLICATION  IN  SARCOMATA 

hospitals  to  remove  it,  but  on  account  of  its  extensive 
infiltration  it  was  found  to  be  impossible  and  the  wound 
was  closed.  x-ray  treatment  was  employed,  and  for  a 
time  some  benefit  seemed  to  be  derived  from  it.  However, 
the  mass  continued  to  grow,  and  it  was  decided  to  use 
radium.  Ten  treatments  were  given,  the  radium  being 
applied  in  different  positions  at  each  sitting,  which  lasted 
for  three  hours  and  were  made  at  intervals  of  three  days. 
The  amount  used  was  11  mg.  in  an  aluminium  capsule  pro- 
tected by  thin  lead  and  several  layers  of  cotton  gauze.  A 
terrific  reaction  followed  over  the  whole  area,  no  doubt  due 
to  the  weakened  condition  of  the  surrounding  skin  from 
the  previous  x-ray  treatment.  Ulceration,  which  was  very 
rebellious,  followed  but  gradually  healed,  except  a  small 
patch  over  the  site  of  the  operative  scar  which  remained  for 
several  months.  The  tumor  in  the  meantime  disappeared, 
although  a  gland  still  remains  in  the  neck,  but  appears  to 
be  stationary.  The  case  is  interesting  as  illustrating  the 
great  care  necessary  in  applying  radium  over  areas  which 
have  previously  received  x-ray  treatment. 


CHAPTER  XVIII. 
APPLICATION  IN  BENIGN  TUMORS. 

Keloids — Warts — Papillomata— Cysts — Adenitis — Goitre — Angiomata — 
Nevi — Pigmented  Moles — Granulomata. 

WHERE  there  has  been  an  overgrowth  of  tissue  it  is 
often  possible  to  cause  a  retrograde  metamorphosis  and 
establish  the  part  in  practically  the  same  condition  as 
existed  before  this  process  was  observed.  Before  the 
tumors  are  placed  under  treatment  it  is  important  to  have 
a  correct  diagnosis,  and  where  possible  a  histological 
examination  should  be  made.  The  line  of  demarcation 
between  the  benign  and  malignant  is  poorly  defined,  and 
under  our  present  knowledge  of  such  conditions  early 
removal  of  all  suspicious  growths  should  be  the  adopted 
rule.  As  a  class  benign  tumors  yield  easily  to  radiation 
and  disappear,  leaving  no  operative  scar,  which  under  some 
circumstances  is  objectionable.  There  are  some  growths, 
however,  which  stand  out  clearly  as  types  for  radiation, 
and  a  good  example  of  this  is  the  keloid. 

Keloids  '  are  overgrowths  of  fibrous  tissue  occurring 
in  a  scar.  The  colored  race  is  particularly  prone  to  these 
overgrowths,  which  often  result  from  most  trivial  injuries. 
In  one  instance  a  colored  man  applied  acetic  acid  to 
remove  some  warts  from  the  back  of  his  neck.  The  growth 
of  these  keloids  where  the  small  warts  had  been  was  many 
times  more  serious.  Another  case  was  that  of  a  young 
17 


258  APPLICATION  IN  BENIGN  TUMORS 

colored  girl  who  had  her  ears  pierced  for  ear-rings,  and  from 
the  site  of  each  puncture  hung  a  tumor  about  the  size  of  a 
cherry.  The  removal  of  these  keloids  by  a  surgical  pro- 
cedure, cautery,  or  other  similar  process,  is  likely  to  be  fol- 
lowed by  a  still  larger  growth.  The  only  form  of  treatment 
to  be  recommended  for  this  condition  is  radiation,  either  by 
the  x-ray,  radium  or  mesothorium.  By  these  rays  extremely 
large  growths  of  fibrous  tissue  can  be  successfully  removed; 
the  slower  they  degenerate  the  better  the  result.  Care 
must  be  taken  not  to  produce  irritation,  lest  the  very  action 
that  originally  caused  these  tumors  be  sufficient  to  start 
the  re-formation  of  this  excess  of  tissue.  The  results  from 
the  different  forms  of  radiation  seem  to  be  about  equal,  and 
a  matter  of  choice  is  difficult  to  determine.  The  method 
of  election  would  simply  depend  upon  the  convenience  of 
obtaining  the  source  of  supply. 

The  technique  is  most  important,  and  while  authors  differ 
to  some  degree,  the  primary  object  is  the  absorption  of  the 
growth  with  the  least  possible  scarring. 

For  removal  of  keloids,  Pinch,  of  the  London  Radium 
Institute,  uses  half-strength  applicators  screened  with  1 
mm.  of  silver  and  exposure  of  fifteen  to  twenty  hours, 
extended  over  three  successive  days,  and  repeated  in  one 
month  where  necessary.  This  gives  a  fair  amount  of  pene- 
tration and  yet  does  not  cut  out  all  the  median  rays.  Bayet 
recommends  using  0.1  to  0.25  mm.  of  lead  as  a  filter,  while 
Wickham  used  a  0.1  mm.  of  aluminium  to  0.6  mm.  of  lead, 
depending  upon  the  strength  of  the  radium  and  the  thickness 
of  the  tissue.  He  has  treated  a  series  of  over  50  cases  with 
good  results  and  no  relapses. 

As  before  stated  the  colored  race  is  especially  prone  to 
the  development  of  these  keloids,  and  they  often  attain 


KELOIDS  259 

an  enormous  size  from  the  most  trivial  injury.  The  fol- 
lowing instance  is  worth  relating:  A  man,  about  twenty- 
nine  years  of  age,  developed  one  of  these  tumors  about 
the  size  of  three  small  apples  extending,  about  an  inch 
from  the  symphysis  of  the  jaw  backward  and  upward 
under  the  angle,  just  below  the  ear;  the  cause  of  this 
growth  was  the  removal  of  a  few  small  glands,  which  were 
supposed  to  be  tuberculous.  The  glands  were  about  the 
size  of  two  or  three  hazel  nuts.  Radiation  was  employed  to 
remove  the  excess  of  fibrous  tissue.  While  under  treatment 
and  the  area  somewhat  herperemic,  he  was  accidently  struck 
over  the  site  of  the  tumor,  which  at  that  time  was  much 
reduced  in  size.  The  blow  was  sufficient  to  cause  a  slight 
abrasion  of  the  skin,  which  removed  the  upper  layer; 
this  caused  the  absorption  of  the  pigment  and  left  the 
area  blanched  white.  The  keloids  absolutely  disappeared 
as  well  as  the  pigment  over  the  site  of  the  abrasion,  which 
covered  an  area  of  about  1  inch  by  1^  inch,  with  some- 
what irregular  borders. 

While  the  masses  that  form  upon  the  colored  race  are 
much  larger  than  those  of  the  white,  when  properly  treated 
they  rapidly  disappear,  leaving  the  skin  of  the  affected  area 
almost  perfect. 

Keloids  following  acne  may  be  greatly  benefited  by  radium, 
where  it  can  be  applied  over  the  small  area  with  greater  ease 
than  the  Roentgen  rays.  The  large  number  of  small,  well- 
localized  areas  which  often  exist  call  for  more  or  less  indi- 
vidual treatment.  If  the  acne  exists  at  the  same  time,  radi- 
ation with  the  Roentgen  rays  is  to  be  preferred,  as  the  whole 
area  and  not  the  individual  groups  require  treatment,  and  a 
general  reaction  should  be  produced.  This  causes  a  sub- 
sidence of  the  pus-forming  process,  and  at  the  same  time, 


260  APPLICATION  IN  BENIGN  TUMORS 

to  some  extent,  an  absorption  of  the  excess  of  fibrous  tissues. 
Should  well-marked  individual  keloids  remain,  they  may  then 
be  treated  by  the  application  of  radium. 

Vicious  scars,  which  are  practically  keloids,  although  not 
necessarily  an  overgrowth  of  fibrous  tissue,  are  the  causes 
of  contraction  and  more  or  less  deformity.  These  scars 
are  often  the  result  of  extensive  burns,  and  when  they  exist 
upon  portions  of  the  body  where  the  skin  is  naturally  soft 
and  yielding  they  produce  considerable  contraction,  which 
at  times  is  not  only  annoying,  but  causes  a  lack  of  usefulness 
of  the  part.  This  is  well  exemplified  in  such  scars  about 
the  eyelid,  where  it  is  drawn  away  from  the  palpable  con- 
junctiva; and  if  not  relieved  will  result  in  ulceration  and 
perhaps  the  loss  of  that  organ.  Very  often  by  careful  radia- 
tion these  scars  can  be  softened  to  such  a  degree  that  the 
function  is  completely  restored.  Aside  from  this  the  comfort 
and  cosmetic  effect  produced  is  gratifying. 

For  the  treatment  of  these  vicious  scars  there  is  very 
little  difference  between  the  use  of  the  radio-active  elements 
and  the  Roentgen  rays;  both  must  be  applied  carefully, 
and  burning  must  be  avoided,  lest  the  condition  be  made 
worse  from  greater  contraction. 

Warts. — Warts  at  times  show  a  marked  tendency  to  recur; 
usually  their  removal  can  be  accomplished  by  some  caustic, 
such  as  nitric  acid,  glacial  acetic  acid,  trichloracetic  acid 
and  many  others,  including  carbon  dioxide  snow.  At  times 
peculiar  influences  will  cause  them  to  disappear,  and  most 
ridiculous  remedies  have  been  employed  with  success.  The 
reason  cannot  be  explained;  but,  as  the  pathology  of  a  wart 
is  practically  unknown,  these  methods  must  be  considered, 
for  the  simple  reason  that  they  are  effective.  The  nervous 
influences,  trophic  or  otherwise,  bear  upon  the  results,  and 


261 


Specimen  of  a  soft  recurring  fungoid  wart;  promptly  disappeared 
after  one  treatment. 

FIG.  63 


Same  finger  after  treatment. 


262 


APPLICATION  IN  BENIGN   TUMORS 


for  this  reason  the  success  of  radiation  must  not  be  consid- 
ered alone  from  its  actual  effect,  but  also  from  its  psychical 
influences;  and  while  the  employment  of  radium,  made  in 
short  applications,  is  usually  successful,  at  times  failures 
will  result  from  some  unknown  influence.  Where  the  wart 

FIG.  64 


Benign  papilloma  treated  with  radium.      (From  Records  of 
Oncologic  Hospital.) 

is  practically  a  papilloma,  due  possibly  to  some  direct 
irritation,  the  application  of  radium  will  be  attended  with 
success  and  recurrence  is  not  likely,  provided  the  cause  is 
removed. 

Papilloma. — Papillomata    are    especially   annoying   when 
upon  parts  of  the  body  where  the  skin  is  contracted  and 


PAPILLOMATA  OR  POLYPI  263 

extended;  in  such  places  as  the  joints  of  the  fingers,  near 
the  mouth,  along  the  nose  or  eyelids.  Here  the  base  of  the 
small  tumor  itself  may  be  cracked  or  split,  causing  bleeding 
and  irritation,  which,  if  continued,  in  time  may  give  rise 
to  malignancy;  therefore,  under  these  circumstances  their 
removal  is  important.  Even  if  other  parts  of  the  body  are 
not  subjected  to  direct  irritation,  the  same  tendency  to 
malignant  degeneration  is  often  observed.  If  their  removal 
cannot  be  accomplished  by  the  application  of  some  caustic, 
radiation  should  be  employed. 

Papillomata  or  polypi  upon  the  mucous  membrane  are  often 
extremely  troublesome,  especially  when  occurring  in  the 
larynx  or  trachea.  Their  removal  by  some  operative 
procedure  leads  to  more  or  less  destruction  of  the  tissues, 
with  the  formation  of  objectionable  scars,  which  usually 
injure  the  voice;  besides  these  disadvantages,  recurrence  is 
usually  to  be  expected.  By  the  use  of  radium  or  mesothorium 
these  tumors  may  be  removed  by  a  few  applications  and 
the  result  is  often  permanent.  This,  however,  has  not  been 
observed  from  the  treatment  of  the  cases  with  x-rays.  Here 
the  results  are  variable  and  recurrence  likely,  in  addition 
to  the  destruction  of  tissue  surrounding  the  larynx  from  the 
needless  hyperemia. 

In  the  treatment  of  laryngeal  and  tracheal  papillomas  the 
applications  may  be  made  from  within  and  directly  to 
the  part  by  using  a  small  applicator  and  cocainizing  the 
larynx  sufficiently  to  tolerate  the  presence  of  an  applicator. 
If,  however,  this  is  not  desirable,  the  radium  may  be  applied 
from  without  by  "cross-fire"  method  and  the  tissue  through 
which  the  rays  pass  to  reach  the  mass  will  be  different  with 
each  treatment.  In  this  way  only  the  diseased  area  receives 
the  full  amount  of  radiation.  Both  methods  have  their 


264  APPLICATION  IN  BENIGN  TUMORS 

advantages.  Where  the  radio-active  element  is  applied 
internally,  directly  to  the  tumor,  the  duration  of  the  appli- 
cation is  much  shorter  than  where  the  external  method  is 
employed.  In  the  first  instance  a  larger  proportion  of  the 
energy  can  be  used,  while  if  it  is  applied  externally  filters 
are  necessary  to  cut  off  the  low  rays. 

Papillomas  occurring  writhin  the  mouth,  nasal  cavities, 
and  pharynx  can  be  readily  treated  by  local  applications 
of  radium;  these  are  more  easily  handled  than  the  former 
class  as  exemplified  by  the  following  case: 

Mr.  H.  R.  S.,  aged  forty-four  years.  About  a  year  ago 
developed  a  small  lump,  one-half  the  size  of  a  pea,  upon 
the  inner  side  of  the  mandible,  just  below  the  cuspid  tooth. 
It  showed  no  tendency  to  bleed  nor  to  ulcerate.  It  had  been 
removed  on  several  occasions  but  promptly  recurred.  The 
histological  report  wras  made  by  Dr.  Allen  J.  Smith,  who 
reported  it  to  be  a  hard  papilloma,  and,  referring  to  the 
tendency  of  these  conditions  to  become  malignant,  urged 
removal  with  wide  dissection  of  the  tissue.  This  operation 
failed  and  the  tumor  again  recurred;  then  radium  was  em- 
ployed, the  mass  having  been  removed  by  "diathermic." 
The  base  of  the  ulcer  was  treated  for  two  hours,  and  two 
days  later  for  three  hours,  with  radium  filtered  only  by  a 
glass  tube  and  aluminium,  each  about  1  mm.  thick.  There 
has  been  no  recurrence. 

Papillomatous  conditions  of  the  bladder  and  rectum  may 
be  treated  in  like  manner.  Where  it  is  possible  to  bring 
the  radio-active  salts  in  direct  contact  with  these  tumors, 
the  time  of  radiation  is  materially  lessened  and  lower  rays 
may  be  employed.  Where  this  is  not  possible,  the  applica- 
tions must  be  made  by  the  "cross-fire"  method  and  calcu- 
lation drawn  accordingly. 


TUBERCULOUS  ADENITIS  265 

Small  recurrent  cysts  are  at  times  presented  for  treatment. 
The  following  is  a  typical  example: 

Miss  A.  J.,  aged  thirty-five  years,  school  teacher,  had 
developed,  about  two  years  previously,  a  small  cyst  upon 
the  mucous  membrane  upon  the  lip,  opposite  the  root  of 
the  right  lateral  incisor  tooth.  It  had  been  removed  sev- 
eral times,  and  the  last  time  the  base  was  well  cauterized. 
-f  1  mg.  .of  radium  filtered  by  a  thin  aluminium  capsule  was 
applied  directly  over  the  cyst  for  three  hours;  three  appli- 
cations were  made  one  week  apart.  At  the  time  of  applica- 
tion the  cyst  was  about  the  size  of  a  pea,  and  the  very 
slight  reaction,  caused  by  the  radium,  subsided  with  the 
disappearance  of  the  tumor.  While  the  character  of  the 
cyst  was  never  determined,  the  patient  has  been  under 
observation  over  four  years  with  no  sign  of  recurrence. 

Simple  Adenoma. — Simple  adenoma  existing  in  other 
tissues  such  as  the  breast,  mouth  and  glandular  structure, 
should  be  carefully  considered  before  treatment.  While  they 
yield,  in  a  fair  proportion  of  cases,  to  radiation  the  chance 
of  error  and  the  likelihood  of  malignancy  must  be  con- 
sidered. Therefore,  a  surgical  operation  is  always  to  be 
preferred  and  an  exact  diagnosis  established;  radiation  may 
subsequently  be  employed  where  the  occasion  justifies. 

Tuberculous  adenitis  has  frequently  been  treated  by  the 
various  forms  of  radiation,  and,  as  a  rule,  favorable  results 
are  to  be  expected.  The  cases,  to  some  extent,  must  be 
selected;  those  having  softened  glands,  containing  a  large 
amount  of  pus,  must  be  opened  and  drained,  before  healing 
from  the  influence  of  radiation  can  be  expected.  Enlarged 
glands  that  are  firm  and  in  the  inflammatory  stage  may  be 
reduced  in  size  and  may  at  times  even  disappear,  but  as  a 
rule  they  shrink  to  a  small,  fibrous  nodule  about  the  size 
of  a  pea  and  remain  in  such  condition  without  recurrence. 


266 

Where  previous  surgical  operations  have  removed  the 
gland,  leaving  sinuses  and  a  large  amount  of  fibrous  tissue 
and  scarring,  the  application  of  radiation  will  aid  materially 
in  the  absorption  of  this  excessive  tissue  and  favor  healing, 
provided  there  are  no  pockets  in  which  pus  collects  to  form 
new  abscesses.  In  this  condition,  or  where  the  gland  contains 
pus,  drainage  is  most  important;  pockets  of  pus  simply 
block  the  radiation  from  the  walls  of  these  cavities,  while 
the  surrounding  tissues  suffer  the  full  force.  Therefore,  the 
damage  done  is  doubled,  the  tissue  that  receives  the  radiation 
does  not  need  it,  and  the  diseased  cell  naturally  escapes  from 
it  by  the  protection  afforded  by  material  which  cannot  be 
influenced  by  the  effects  of  these  rays.  As  a  rule,  these 
glands  do  not  occur  singly,  but  are  spread  over  a  wide  area. 
Under  these  circumstances  the  Roentgen  rays  afford  a 
method  which  fulfils  the  requirements  somewhat  better 
than  the  application  of  radium.  Most  cases  of  simple 
glandular  affection  are  usually  removed  by  some  surgical 
procedure,  wrhich  has  the  advantage  of  placing  the  tissue 
in  condition  for  inspection  and  enabling  the  diagnosis  to 
be  confirmed,  thus  avoiding  the  possibility  of  a  mistake, 
which  under  circumstances  such  as  these  is  most  likely  to 
occur.  Therefore,  when  these  cases  present  themselves  for 
treatment  by  radiation,  and  have  previously  submitted  to 
several  operations,  the  diagnosis  can  be  absolutely  con- 
firmed, as  the  disease  usually  exists  over  a  widespread  area. 

Reports  of  tuberculous  glands  treated  by  radiation  with- 
out operation  have  been  made,  and  where  this  proved 
successful  the  damage  to  tissue  and  the  usual  unsightly 
scarring,  so  frequently  seen,  was  avoided.  However,  under 
some  circumstances  the  results  have  not  been  favorable; 
the  gland  not  being  reduced  in  size  an  operation  had 


TUBERCULOUS  ADENITIS  267 

subsequently  to  be  performed.  This  is  usually  attended 
with  considerable  difficulty;  as  the  fibrous  tissue,  formed 
under  these  conditions,  is  extremely  dense  and  makes 
dissection  most  tedious.  The  assertion  has  been  made 
that  the  treatment  of  these  cases  before  operation  is  not 
justifiable;  that  the  gland,  being  tuberculous,  should  be 
removed ;  and  where  this  is  not  done,  the  infection  is  allowed 
to  remain  in  the  system  to  recur  at  some  future  time.  This, 
however,  has  not  been  proved  by  the  observation  of  cases, 
and  it  appears  that  recurrence  is  less  likely  in  cases  treated 
by  the  Roentgen  rays  or  radium  than  in  those  treated  by 
operation,  where  it  is  quite  frequent.  Therefore  the  infec- 
tion of  open  tissue  seems  more  probable  than  where  the 
blood  and  nerve  supply  has  not  been  injured. 

Where  these  radio-active  elements  are  employed  in  the 
treatment  of  tuberculous  glands  they  are  prepared  in  the 
same  manner  as  where  deep  treatment  is  desired.  The  low 
rays  are  filtered  by  1  or  2  mm.  of  lead  and  the  applications 
arranged  to  cover  the  whole  site  of  disease;  this  at  times  is 
difficult.  The  amount  of  radiation  must  not  be  excessive; 
it  is  better  to  adopt  a  procedure  of  several  seances  with  a 
month  intervening.  This  seems  to  be  more  efficient  than 
continuous  treatment. 

Tuberculous  laryngitis,  papillomas  or  ulcerations  of  this 
nature,  occurring  in  the  larynx,  heal  in  a  large  proportion  of 
cases  treated  by  this  method ;  but  as  this  local  manifestation 
often  depends  upon  the  same  disease  existing  in  the  lungs, 
the  prognosis  rests  entirely  on  the  possibility  of  relieving 
the  latter.  Where  this  is  possible,  the  health  of  the  indi- 
vidual may  be  completely  restored,  and  therefore,  when 
such  cases  come  under  observation,  it  is  most  important  to 
instigate  a  thorough  medical  regimen. 


268 


APPLICATION  IN  BENIGN  TUMORS 


Tuberculous  diseases  of  the  bones  and  joints  are  only 
influenced  to  a  limited  extent  by  radiation. 

Goitre.- — Goitre,  in  its  various  forms,  has  been  treated 
by  the  Roentgen  rays  and  also  by  radium;  the  results 
are  by  no  means  uniform  although,  a  fair  proportion  are 
attended  by  success.  This  fact  is  all  the  more  contradic- 
tory, for,  as  referred  to  in  Chapter  X,  under  the  subject, 

FIG.  CO 


Abbe's  case  of  exophthalmic  goitre 
before  treatment. 


Same  patient  as.  Fig.  65.     After 
treatment. 


Natural  Springs,  there  has  been  some  tendency  to  attach 
the  development  of  goitres,  in  certain  localities,  to  the  high 
radio-activity  existing  in  these  natural  waters.  This  may  or 
may  not  have  a  bearing  upon  this  subject,  for  the 
form  of  goitre  least  affected  by  radiation  is  the  cystic  variety 
observed  in  those  localities.  This  variety  seems  to  have  less 
systemic  effect;  its  greatest  annoyance  being  the  disfigure- 
ment it  produces.  As  a  rule,  it  is  a  rather  indifferent  tumor 


GOITRE    .  269 

and  not  likely  to  seriously  interfere  with  the  individual's 
comfort.  Treated  by  either  form  of  radiation,  it  may  usually 
be  greatly  reduced,  and  in  some  instances  be  practically 
brought  to  the  size  of  the  normal  gland. 

Goitre  occurring  in  Graves'  disease,  exophthalmic  goitre, 
has  also  been  greatly  reduced  in  size  by  radiation,  causing 
the  local  manifestation  to  subside,  as  well  as  the  other  signs 
and  symptoms  usually  present  in  that  disease.  The  rapid 
beating  of  the  heart  and  the  protruding  eyes  disappear,  to  a 
great  extent,  before  the  goitre  itself  is  absorbed.  This 
gives  a  degree  of  comfort  to  the  patient  while  under  treat- 
ment. The  form  of  radiation  usually  employed  in  most 
of  the  cases  that  have  been  reported  was  the  Roentgen 
rays.  Dr.  Abbe1  reports  an  interesting  case  which  is  given 
in  detail  as  follows: 

"Miss  B.,  aged  twenty-one  years,  lived  in  the  suburbs  of 
New  York  and  enjoyed  the  finest  health  until  she  was 
overcome  by  the  present  trouble  while  pursuing  a  course 
of  study  in  a  hospital  training-school  for  nurses,  a  year  and 
a  half  ago.  She  noticed  her  throat  began  to  swell  in  the 
centre  and  at  both  sides.  This  has  progressed  steadily  up 
to  the  present  time.  Palpitation  soon  followed,  and  became 
so  bad  that  she  had  to  give  up  her  work  and  return  home. 
She  was  then  sick,  and  obliged  to  go  to  bed,  with  extreme 
nervousness,  restlessness,  and  a  feeling  of  heat  and  feverish- 
ness,  though  not  having  actual  fever  so  far  as  she  knew. 
Added  to  these  were  severe  headaches,  especially  severe  in 
the  temples  and  eyes.  This  was  relieved  somewhat  by  lying 
down,  so  that  she  spent  much  time  in  bed;  though  in  the 
recumbent  posture  she  experienced  a  sense  of  suffocation  and 

i  Archives  of  the  Roentgen  Rays,  1905. 


270  APPLICATION  IN  BENIGN  TUMORS 

smothering.  Her  muscles  trembled,  and  she  was  unable 
to  walk  upstairs,  except  very  slowly,  on  account  of  palpi- 
tation. Her  eyes  felt  full  and  burning,  and  began  to  pro- 
trude. One  year  ago  her  voice  became  husky.  Her  weight 
was  175  pounds;  appetite  hearty;  digestion  excellent,  and 
bowels  a  little  torpid;  pulse-rate  140.  She  has  been  obliged 
to  remain  quietly  in  her  home. 

"Examination. — The  patient  was  able  to  walk  about 
slowly;  any  exertion  at  once  showing  in  smothered  breathing 
and  palpitation.  This  long  ago  incapacitated  her  for  any 
household  duties.  The  photograph  shows  the  outline  of  the 
thyroid  enlargement  marked  in  iodine  before  photographing. 
The  circumference  around  her  neck  was  16f  inches. 

"Six  weeks  later  I  sent  her  to  a  private  room  at  St.  Luke's 
Hospital,  and  made  an  application  of  radium  as  follows: 
Under  cocain  anesthesia  I  made  a  small  median  incision 
in  the  neck,  dissecting  down  to  the  isthmus  of  the  thyroid, 
carefully  avoiding  large  veins.  The  hypertrophied  middle 
lobe  was  apparently  If  inches  thick.  Into  this  I  thrust  a 
small,  sharp  bistoury,  making  a  deep  enough  incision  to 
bury  a  sterilized  tube  of  radium  at  right  angles  to  the  skin, 
1  inch  deep.  It  was  held  in  place  by  sterile  dressing  and 
straps,  the  patient  keeping  her  head  fairly  quiet  for  twenty- 
four  hours.  The  glass  tube  was  |  inch  in  diameter,  and 
contained  10  eg.  of  Curie  radium  (300,000  activity).  The 
tube  was  removed  after  twenty-four  hours,  and  the  wound 
closed  with  strapping.  Nothing  could  be  seen  unusual  in 
the  healing  of  the  wound  or  in  the  appearance  of  the  tissues. 

"She  returned  home,  and  for  a  time  was  very  much  as 
before.  Her  own  narrative  is  that  for  a  month  the  gland 
seemed  just  a  little  more  swollen  and  spongy.  Then  the 
swelling  diminished  rapidly,  and  eight  weeks  later  was  as 


GOITRE  271 

small  as  shown  in  the  later  photograph.  All  her  unpleasant 
symptoms  disappeared  except  the  husky  voice,  due,  perhaps, 
to  enlarged  tonsils,  which  I  have  since  removed.  On  examin- 
ing her  four  months  later,  after  the  one  radium  application, 
I  found,  however,  some  remaining  tachycardia;  pulse  105, 
which  could  be  run  up  to  120. 

"The  patient  looks  and  feels  entirely  well;  attends  all 
household  duties,  runs  upstairs  without  palpitation,  plays 
tennis  every  day,  and  \valks  several  miles;  has  no  headache, 
eyes  are  normal,  and  is  free  from  tremor,  restlessness,  or 
smothering  feeling  on  lying  down.  The  maximum  neck 
measurement  is  now  15  inches,  and  the  goitrous  appearance 
would  scarcely  be  observed. 

"Examination  of  the  thyroid  shows  it  to  be  about  one- 
sixth  of  its  former  bulk — a  reduction  in  every  diameter, 
as  shown  by  the  iodine  outline  in  the  photograph.  No 
treatment  or  change  in  habits  of  life  occurred  during  the 
four  months,  except  the  occasional  use  of  a  small  quantity 
of  Carlsbad  salts  in  the  morning  and  a  rectal  enema  of 
warm  saline  solution. 

"The  complex  symptoms  of  Graves'  disease  refer  so  much 
to  a  sympathetic  disturbance  that  the  goitre  is  regarded  as 
only  one  disturbed  organ;  hence  the  operations  on  it  and  on 
the  cervical  sympathetic  ganglia,  which  seem  to  control 
it,  are  disconnected  by  many  medical  men  as  not  going 
to  the  root  of  the  matter,  but  as  relieving  only  part  of  the 
disturbance.  Nevertheless,  it  would  seem  that  where  the 
goitre  has  been  established,  its  own  disturbed  secretions  add 
to  the  general  systemic  upset,  and  tend  to  complete  the 
disaster. 

"In  what  way  can  we  imagine  radium  to  act  favorably? 
In  two  ways:  on  the  hyperplasia  of  the  gland,  causing  a 


272  APPLICATION  IN  BENIGN   TUMORS 

retrograde  change  in  all  overgrown  tissue,  quite  as  we  see 
it  in  other  instances.  Second,  by  irradiating  the  ganglia 
of  the  sympathetic,  even  of  the  unapproachable  thoracic 
and  cardiac  ganglia.  It  is  not  inconceivable  that  the  regular 
electrons  (beta-rays)  discharged  from  the  radium,  and 
wrhich  penetrate  dense  structures  at  a  great  distance,  are 
not  detrimental  to  living  structures,  but  may  supply  to 
disturbed  nerves  the  very  electric  nervation  they  lack,  or 
to  cells  of  hyperplastic  tissues  the  necessary  inhibitive  power 
to  control  their  erratic  growth." 

Angioma. — Angiomas  and  conditions  closely  allied  to 
these  tumors,  such  as  nevi  and  "port-wine  stains,"  have  been 
treated  by  the  Roentgen  rays  and  also  by  the  application 
of  radium.  The  result  from  the  Roentgen  rays  has  not  been 
particularly  encouraging,  as  the  resulting  scar  with  the 
amount  of  telangiectasis  is  apt  to  be  more  disfiguring  than 
the  uniformly  distended  capillaries;  besides,  the  reaction 
produced  for  the  contraction  of  these  vessels  at  times  causes 
a  burn  that  under  some  circumstances  is  difficult  to  heal. 
With  radium,  however,  these  protracted  burns  need  not  be 
feared,  and  while  a  number  of  authors  claim  most  brilliant 
results  at  times,  the  actual  effect  cannot  always  be  regarded 
as  perfect.  The  contracted  vessels  produce  more  or  less 
fibrous  tissue  which  is  by  no  means  as  sensitive  to  dilatation 
and  contraction  as  the  natural  skin.  Therefore,  upon 
blushing  or  passing  from  heat  to  cold,  the  scars,  which 
under  ordinary  conditions  would  not  be  observed,  are  per- 
fectly evident;  while  the  cosmetic  effect  may  be  good  under 
ordinary  circumstances,  the  traces  of  the  original  trouble 
are  more  or  less  in  evidence. 

The  treatment  of  nevi  requires  some  experience  and  must 
not  be  undertaken  except  by  one  who  thoroughly  under- 


AN  G 10  MA 


273 


stands  the  specimens  of  radio-active  elements  at  his  com- 
mand. They  must  be  carefully  used,  as  too  severe  a  reaction 
will  bleach  the  tissue  a  dead  white,  and  it  is  far  better  not 
to  have  sufficient  reaction,  which  will  only  make  another 
application  necessary.  As  only  the  superficial  effect  is  desired 
from  these  treatments,  the  exposures  should  be  very  short, 
the  radium  need  not  be  of  great  strength,  and  the  filter  may 
be  omitted,  although  under  some  circumstances,  when  the 
rays  penetrate  the  tissues,  a  0.01  to  0.1  aluminium  filter 
is  desirable.  Pinch  uses  an  aluminium  filter  that  does  not 
exceed  0.02  mm.;  he  also  calls  attention  to  the  fact  that 
these  flat  capillary  nevi  ("port-wine  stains")  are  the  most 
difficult  to  treat  especially  when  they  are  infiltrated  to 
some  degree. 

FIG.  67 


Cavernous  nevi  treated  with  radium.    The  tumor  was  originally  about 
the  size  of  a  cherry  over  the  left  eyebrow. 

In  the  cavernous  type  of  nevi  the  treatment  must  be 
necessarily  deeper.  While  the  conditions  are  similar  to  the 
former,  the  vessels  are  much  larger  and  the  amount  of  tissue 
absorption  is  in  greater  proportion.  The  results,  however, 

18 


274  APPLICATION  IN  BENIGN   TUMORS 

are  usually  satisfactory  and  very  little  disfigurement  is  pro- 
duced after  the  vessels  have  been  destroyed.  The  radiation 
employed  under  these  circumstances  must  necessarily  be 
stronger,  and  a  filter  of  thin  lead  is  used.  While  some  reac- 
tion may  be  desired,  it  must  not  be  too  severe,  otherwise 
a  scar  may  result. 

Erectile  angiomas  are  a  still  more  exaggerated  type  of 
these  tumors.  The  treatment  must  be  regulated  by  cir- 
cumstances, be  of  a  penetrating  character  and  "cross-fire" 
tactics  usually  have  to  be  adopted. 

Pigmented  Nevi  or  Moles. — Moles  may  or  may  not  be 
covered  with  hair,  and  while  they  might  be  included  in  the 
class  of  superficial  nevi,  they  contain  more  fibrous  tissue 
and  therefore  are  somewhat  more  rebellious  to  treatment. 
They  require  more  radiation  and  a  heavier  filter  to  produce 
reaction  of  sufficient  depth  to  eradicate  them.  The  results, 
however,  from  radiation  are  extremely  good  and  far  better 
than  any  other  form  of  treatment. 

Granulomas. — Granulomas  include  tumors  of  indefinite 
pathology;  they  usually  develop  upon  ulcers  of  low  vitality 
and  cannot  be  assigned  to  any  distinct  group.  Under 
ordinary  treatment  they  are  extremely  rebellious  and  at 
times  tend  toward  a  malignant  degeneration.  Radiation, 
as  a  rule,  causes  them  to  yield,  and  the  form  adopted 
depends  upon  their  depth  and  extent.  It  seems  needless 
to  call  attention  to  the  fact  that  if  any  direct  cause  of 
irritation  exists  it  must  be  removed  before  treatment. 


CHAPTER   XIX. 
ANALGESIC  EFFECTS. 

Relief  of  Pain  from  the  Roentgen  Rays;  from  Radio-active  Elements — 
Neuralgias — Herpes  Zoster — Pruritus — Application  of  Radio-active  Mud 
— Baths — Compresses  and  Packs— Conclusions. 

THE  effect  of  radiation  upon  the  sensory  nervous  system 
is  one  of  considerable  interest,  and  was  first  noticed  soon 
after  the  Roentgen  rays  became  an  accepted  form  of  treat- 
ment for  malignant  diseases.  Many  early  observers  noticed 
that,  before  any  evidence  of  change  could  be  detected  in 
the  disease  process,  quite  often  patients  would  voluntarily 
state  that  the  pain  had  to  a  great  extent  disappeared.  This 
at  first  was  thought  to  be  due  more  to  a  psychic  influence 
that  is  commonly  observed  in  certain  classes  of  cases  when  a 
change  in  any  form  of  treatment  has  been  made.  Some  doubt 
was  cast  upon  this  analgesic  effect,  for,  not  infrequently, 
cases  that  did  not  respond  to  radiation  also  spoke  of  the 
same  relief.  As  the  field  broadened  and  the  treatment  of 
other  diseases  was  included,  the  same  relief  from  pain  was 
frequently  noticed;  even  at  times  certain  conditions,  simply 
submitted  for  a  radiograph,  would  experience  this  relief;  the 
exposures  under  those  circumstances  being  much  longer 
than  they  are  at  the  present  day. 

Neuralgia. — From  these  different  observations  certain 
painful  conditions,  such  as  neuralgia,  were  subjected  to 
radiation,  purely  for  the  relief  of  pain;  and  one  of  the  first 


276  ANALGESIC  EFFECTS 

to  call  attention  to  the  fact  was  Dr.  Charles  Lester  Leonard, 
of  Philadelphia;  and  since  that  time  many  other  authors 
have  reported  cases  treated  by  these  methods  with  more  or 
less  success,  depending  to  some  extent  upon  their  origin. 
In  cases  where  the  neuralgia  has  a  direct  cause,  as  pressure 
from  tumor,  indigestion,  or  disturbance  of  the  eye,  radiation 
necessarily  fails,  and  before  subjecting  these  cases  to  treat- 
ment, care  should  be  exercised  to  eliminate  any  direct  cause. 

Herpes  zoster  is  often  relieved  of  its  intense  burning  pain 
by  mild  radiation;  and  it  will  be  found  particularly  useful 
in  the  more  chronic  forms,  which  tend  to  linger  over  one 
locality.  Besides  relief  from  the  pain  in  these  cases  it  is 
believed  by  some  to  hasten  repair.  Considering  the  fact 
that  the  exact  pathology  of  this  disease  is  not  definitely 
known,  the  role  radiation  plays  in  repair  must  necessarily 
be  doubtful. 

Pruritus. — The  action  in  pruritus  is  similar  to  that  observed 
in  herpes.  The  relief  from  the  intolerable  itching  is  often 
very  prompt;  here  no  doubt  the  irritation  is  entirely  local, 
and  due  to  the  direct  action  upon  the  inflamed  skin. 


METHODS  OF  APPLICATION. 

Under  all  these  conditions  the  radio-active  salt  has  been 
applied  in  such  strength  as  to  require  it  to  be  mounted  upon 
applicators  in  some  one  of  the  different  forms;  either  the 
capsule  containing  the  salt  or  upon  a  flat  varnished  appli- 
cator, the  latter  form  being  usually  more  convenient  where 
the  cause  of  the  pain  is  superficial,  as  in  pruritus.  At  the 
same  time  a  large  area  is  covered  and  the  amount  of  radia- 
tion is  proportionately  larger.  Where  the  origin  of  the  pain 


METHODS  OF  APPLICATION  277 

is  deeper,  as  in  neuritis  or  neuralgia,  fairly  deep  penetrat- 
ing rays  are  needed  and  a  moderate  amount  of  filtration 
is  necessary. 

Mud. — The  relief  obtained  from  radio-active  mud  is  not 
to  be  questioned,  but  whether  it  is  due  to  the  feeble  amount 
of  radio-activity  which  it  eliminates,  or,  like  any  of  the 
other  kaolin  plasters,  where  the  beneficial  effect  is  due  to  the 
production  of  local  warmth  and  fixation,  might  give  rise  to 
considerable  argument.  In  fact,  mud  was  used  in  exactly 
the  same  manner  before  radio-activity  was  known;  and  the 
majority  of  radio-active  muds  placed  upon  the  market  are 
either  worthless  or  else  so  feeble  that  the  ordinary  brick 
clay  would  be  a  fair  rival.  As  results  have  been  reported 
from  the  use  of  such  material  it  must  necessarily  bring 
some  degree  of  skepticism  upon  this  practice. 

If  these  clays  are  to  be  used  for  their  radio-activity  they 
should  give  off  enough  radiation  to  be  detected  by  the 
ordinary  electroscope  and  under  ordinary  conditions;  this 
amount  of  activity  should  also  be  registered.  Before  deduc- 
tions are  made  upon  the  effects  of  these  applications,  the 
relief  afforded  by  the  ordinary  kaolin  plaster  must  be  taken 
into  consideration. 

Baths. — The  beneficial  effects  of  bathing-waters  should 
be  considered  in  exactly  the  same  manner  as  the  muds, 
and  again  the  radio-activity  must  be  of  such  strength  as 
to  have,  some  distinct  effect.  The  addition  of  a  certain 
quantity  of  water  containing  refuse  of  old  emanations  or 
even  a  small  quantity  of  active  emanation  or  radium  salt, 
hardly  gives  enough  activity  to  a  bathtubful  of  water  to 
make  it  rate  favorably  with  many  ordinary  wrells. 

No  doubt  the  relief  afforded  under  these  conditions  is 
as  much  due  to  the  process  of  bathing  as  it  is  to  the  activity 


278  ANALGESIC  EFFECTS 

of  the  water;  and  when  these  waters  are  to  be  used  for  their 
radio-active  effect,  they  must  he  of  sufficient  strength  and 
administered  under  a  proper  regimen. 

The  painful  conditions  treated  by  local  applications  of 
radio-active  mud  or  water  are  of  an  entirely  different  nature 
from  those  where  radiation  is  received  directly  from  radium. 
They  are,  as  a  rule,  less  acute,  and  tend  more  toward  the 
chronic  type  of  disease,  such  as  the  arthritic  conditions  of 
so-called  gout  or  rheumatism,  inflammatory  conditions  of 
the  serous  membrane  in  general,  and  neurogenic  conditions 
which  are  somewhat  localized.  It  has  been  claimed  that  the 
pain  in  such  diseases  as  multiple  sclerosis,  tabes,  and  other 
spinal  degenerations,  has  been  greatly  relieved  in  some 
instances. 

Compresses. — Under  some  circumstances  the  local  appli- 
cations of  these  radio-active  elements  are  made  in  the 
form  of  compresses;  or  in  a  pack,  when  the  whole  body 
is  to  be  covered.  These  compresses  are  usually  made  of 
several  layers  of  gauze  saturated  with  radio-active  water, 
then  bound  to  the  affected  part;  and  when  the  moisture 
is  desired,  should  be  covered  with  oiled  silk,  or  rubber 
tissue.  This  depends  entirely  upon  the  effect  desired  and 
compares  exactly  with  moist  and  dry  compresses  when 
applied  without  the  radio-active  material.  The  same  pro- 
cedure is  adopted  when  a  general  pack  is  given.  The  dis- 
advantage of  this  method  is  that  the  radio-active  elements 
of  the  outer  layers  of  the  compress  have  very  little  action 
upon  the  part;  while  in  the  bath,  the  free  movement  of  the 
liquid  favors  enosmosis  and  exosmosis.  The  compresses, 
however,  have  much  the  same  effect,  to  a  limited  degree, 
and  can  be  adopted  when  baths  are  not  desired.  They  can 
also  be  continued  for  a  longer  time  than  the  bath,  and  the 


METHODS  OF  APPLICATION  279 

absorption  of  these  radio-active  elements  will  be  more 
prolonged,  although  not  so  intense,  for  the  same  amount 
of  area  exposed. 

The  actual  amount  of  relief  afforded  by  radiation  under 
these  procedures  is  still  sub  judice,  and  requires  the  correla- 
tion of  a  large  series  of  cases  before  actual  conclusions  of 
any  definite  nature  can  be  made  possible. 


CHAPTER  XX. 
RADIUM  IN  INTERNAL  MEDICINE. 

Its  Absorption  and  Elimination — Dosage — Effects  upon  the  System — 
Diseases  in  which  it  has  been  Employed — Centra-indications — Conclusions. 

THE  systemic  effect  noticed  after  the  internal  administra- 
tion of  radium  is  believed  by  many  authors  to  be  due  to 
the  a-radiation.  Considering  the  minute  dosage  and  aside 
from  any  possible  influence  it  could  have  as  a  salt,  this 
view  cannot  be  refuted  as  the  /3-  and  7-radiation  are  in  such 
small  proportions  that  it  would  seem  quite  probable  they 
played  only  a  minor  role.  It  is  usual  to  employ  the 
emanation  in  solution  with  some  liquid,  as  water,  for 
bathing,  drinking  or  injections  hypodermically.  It  may 
be  used  in  other  liquids  or  even  solids,  such  as  charcoal, 
and  in  those  instances  where  it  is  desired,  air  or  oxygen  can 
be  charged  and  taken  into  the  body  by  breathing  this  mix- 
ture directly  from  some  form  of  apparatus  or  in  an  enclosed 
cabinet  or  room.  If  the  action  of  radium  is  derived  from 
the  a-radiation,  the  emanation  and  the  first  two  elements 
of  the  "product  of  rapid  change"  are  responsible  for  most 
of  this  action ;  and  as  the  amount  of  the  emanation  is  respon- 
sible for  the  subsequent  rapidly  changing  elements,  the 
dosage  in  all  events  depends  entirely  upon  the  emanation. 
It  must  also  be  remembered  that  the  emanation,  being 
a  gas,  is  eliminated  from  the  body  under  exactly  the  same 
law  of  the  mixtures  of  gases,  in  any  osmotic  change,  but 


RADIUM  IN  INTERNAL  MEDICINE  281 

is  much  slower,  due  to  its  density,  which  is  far  greater  than 
most  of  the  ordinary  gases  known.  However,  where  a  slower 
elimination  is  desired,  radium  salts  are  to  be  preferred; 
but  here  the  proportion  of  activity  is  only  equal  to  that  of 
the  emanation  which  is  undergoing  disintegration  at  that 
time,  plus  the  very  feeble  a-radiation  of  the  radium  element 
proper,  which  in  contrast  to  the  three  successive  elements 

FIG.  68 


Apparatus  and  method  employed  for  breathing  air  charged  with  the 
emanation  of  radium  or  thorium. 


is  rather  meager.  In  other  words,  the  radium  salt  gives  a 
slower  and  more  prolonged  effect  than  the  emanation; 
the  time  depending  entirely  upon  how  long  these  salts  are 
contained  within  the  body,  which  in  turn  depends  upon 
their  solubility.  The  insoluble  salts,  if  administered  by 
mouth,  in  all  probability  simply  pass  through  the  gastro- 
intestinal tract,  and  are  to  all  intents  not  absorbed;  but 
the  emanation  given  off  by  them  is  absorbed  and  this 


282  RADIUM  IN  INTERNAL  MEDICINE 

in  turn  disintegrates  into  the  other  radium  elements  in  the 
juices  of  the  body,  in  the  proportion  of  that  which  is  con- 
tained within  the  body  before  elimination.  There  seems 
to  be  less  likelihood  of  producing  alarming  results  with 
the  radium  elements  than  with  those  of  the  corresponding 
salts  of  thorium,  possibly  due  to  the  fact  that  the  radium 
salts  are  less  active  in  their  disintegration.  The  usual 
method  of  employment  of  radium  is  in  the  form  of  the 
emanation,  which  has  an  average  life-period  of  five  and  a 
half  days.  The  emanation  of  thorium  has  a  period  of  life  of 
seventy-six  seconds,  and  therefore  its  rapid  disintegration 
does  not  permit  its  partial  elimination  from  the  body  as  a 
gas  in  the  same  manner  as  the  former.  However,  wyhere 
a  very  marked  reaction  is  desired,  the  thorium  elements 
are  to  be  preferred. 

Dosage. — Dosage  depends  somewrhat  upon  the  desired 
effect  but  may  be  divided  into  two  classes.  First, 
those  which  call  for  slight  exhilaration  in  the  physiological 
forces,  and  second,  those  which  call  for  a  profound  effect. 
In  the  former  baths,  drinking-water,  and  the  breathing  of 
relatively  small  amounts  of  radio-active  water  or  air  are 
employed,  and  continued  for  some  time.  A  month  or  two 
before  cessation,  then  after  an  intermission  of  a  few  wTeeks 
or  a  month,  another  course  begins,  and  this  regimen  is  con- 
tinued until  the  desired  result  is  obtained  or  the  treatment 
for  some  reason  is  abandoned.  On  the  other  hand,  where  a 
profound  effect  is  desired,  hypodermic  injections  are  given 
into  the  deep  muscular  tissues,  or  where  a  still  more  rapid 
action  is  desired,  are  given  directly  into  one  of  the  veins. 
Where  this  procedure  is  adopted,  the  ordinary  method  of 
giving  these  injections  must  be  rigidly  employed.  At 
times  there  may  be  some  reaction  locally,  particularly  if 


FIG.  69 


Large  emanator  for  charging  air.  The  small  cylinders  (r)  contain  a 
solution  of  radium;  the  arm  (a)  rotates  and  is  adjusted  by  a  lock  attach- 
ment that  mechanically  opens  the  cylinder  (r)  to  which  it  is  attached. 
Oxygen  is  supplied  by  the  tank  t,  while  the  apparatus  contained  within  T 
is  used  for  pumping  the  exhausted  air  from  the  room.  The  emanation  from 
one  small  cylinder  is  for  one  day's  treatment. 


284 


RADIUM  TN  INTERNAL  MEDICINE 


the  salt  is  one  of  those  which  is  not  easily  dissolved;  it, 
however,  is  rarely  employed. 


FIG.  70 


Emanator  for  charging  drinking-water.     The  handle  on  the  side  prevents 
the  withdrawal  of  an  excess  amount. 


The  different  metabolic  processes  of  the  body  are  mate- 
rially affected  and  there  is  more  or  less  disturbance  of  the 
relation  of  change  in  all  albumin  and  sugar  compounds, 
as  well  as  in  the  purin  products.  These  changes  produce  a 
decided  difference  in  the  gases  eliminated  by  the  lungs;  the 
interchange  of  the  oxygen  and  carbon  dioxide  are  rela- 
tively higher,  as  are  the  compounds  of  nitrogen,  which  is 
noticed  more  especially  in  the  formation  of  urea;  and  by  its 
diuretic  action  the  amount  of  urine  and  its  constituents  are 


PNEUMONIA  AND  OTHER  PULMONARY   DISEASES     285 

decidedly  increased.  There  is  also  a  marked  stimulation 
of  the  organs  of  generation,  both  in  the  male  and  female, 
which  is  specially  noticeable  in  women  suffering  from 
amenorrhea. 

Changes  are  often  observed  in  the  blood,  particularly  in 
the  beginning,  when  there  may  be  a  decided  leukocytosis. 
This  may  be  influenced  by  the  action  of  these  radio-active 
salts  upon  the  bone-marrow,  where  it  is  supposed  to  be 
stored.  The  blood -pressure  often  rises  abruptly,  then 
gradually  sinks  until  it  goes  below  normal  and  remains 
there  for  an  indefinite  period,  depending  upon  the  dosage. 
Cases  having  myocarditis  and  extensive  arteritis  must  be 
observed  carefully  when  under  treatment.  While  the  sec- 
ondary effect  is  most  desirable,  the  primary  effect  must  be 
carefully  guarded. 

Pneumonia  and  Other  Pulmonary  Diseases. — Von  Noorden 
placed  a  patient  suffering  from  croupous  pneumonia  in  a 
room  where  the  air  was  charged  with  100  Mache  units  of 
emanation  per  liter  for  the  influence  upon  the  circulation 
and  metabolism.  This  caused  a  decided  fall  in  the  tem- 
perature, with  a  rapid  absorption  of  the  exudate.  The 
subjective  symptoms  were  also  much  influenced  during  the 
time  spent  within  the  emanatorium,  the  patient  being  able 
to  breathe  with  decidedly  more  freedom.  Other  authors 
have  treated  obstinate  cases  of  chronic  bronchitis,  bronchi- 
ectasis,  and  allied  conditions  by  similar  methods. 

Rheumatism  and  Gout. — The  various  forms  of  rheumatism, 
gout  and  diseases  of  this  nature  are  to  a  very  marked 
degree  influenced  by  drinking  or  bathing  in  waters  charged 
writh  radium  or  its  disintegration  products,  and  where  the 
severity  of  the  case  calls  for  a  more  profound  influence, 
the  desired  result  may  be  obtained  from  hypodermic  or 


286  RADIUM  IN  INTERNAL  MEDICINE 

intravenous  injection.     To  these  points  reference  has  been 
made  under  other  chapters. 

In  diabetes  mellitus  the  influence  upon  metabolism  is 
reported  to  have  caused  to  some  extent  a  lessening  of  the 
glycosuria.  This  was  accomplished  by  drinking  water 
containing  a  high  percentage  of  emanation.  The  influence 
in  lessening  the  pain  that  often  accompanies  the  neuritis 
in  these  cases  was  also  quite  marked. 

It  has  been  found  of  value  in  corpulency  for  the  same 
influence  upon  the  metabolism  of  the  tissues  of  the  system. 

Anemia. — In  the  various  forms  of  anemias,  both  primary 
and  secondary,  radium  may  be  found  of  value  in  conjunc- 
tion with  iron  and  other  forms  of  treatment;  especially  in 
those  cases  where  there  is  a  decided  splenic  involvement; 
or  where  the  lymph  glands  are  enlarged  as  in  tuberculosis 
of  these  glands;  or  in  those  cases  which  tend  to  bronchial 
asthma.  In  splenomegaly  the  internal  treatment  should 
be  aided  with  external  radiation.  While  the  blood  in  these 
conditions  may  be  markedly  influenced,  the  actual  cause 
of  the  existing  disease  is  not  materially  altered. 

Diseases  of  the  Nervous  System. — Cases  of  neuritis  and 
neuralgia  have  been  influenced,  and  under  some  conditions 
relief  has  been  complete.  This,  however,  depends  to  some 
extent  upon  the  direct  underlying  cause.  In  a  list  of  73 
cases  of  sciatica,  published  by  Sommer,  40  were  cured,  23 
improved,  and  10  were  not  influenced  by  the  treatment. 
The  pain  that  accompanies  the  cases  of  locomotor  ataxia 
is  also  relieved  in  the  same  manner.  Even  such  diseases 
as  paralysis  agitans,  multiple  sclerosis,  syringomyelia,  and 
Friedreich's  ataxia  were  reported  to  have  been  improved. 
The  usual  method  employed  in  the  treatment  of  these 
conditions  has  been  the  drinking  of  water  containing  the 


CONCLUSIONS  287 

emanations,  accompanied  with  baths  or  external  radiation, 
where  the  local  character  of  the  process  favors  this  method. 
Intravenous  injection  is  only  employed  in  acute  cases  where 
a  reaction  of  a  most  decided  nature  is  desired.  Where  the 
baths  or  local  applications  of  packs  or  compresses  are  to  be 
employed,  the  routine  procedure  of  some  institution  is  most 
desirable,  and  the  results  from  favorable  surroundings  seem 
to  be  far  better  than  those  where  the  patient  has  the  liberty 
of  his  home.  In  cases  such  as  trigeminal  neuralgia  or  sciatica 
the  process  may  require  local  radiation  from  a  strong  appli- 
cator containing  enough  radium  to  produce  some  reaction, 
made  by  ordinary  methods;  while  in  cases  of  syringomyelia 
and  other  spinal  disorders  the  radiation  of  the  spine  may 
be  required  in  the  same  manner. 

Caution  should  always  be  taken  in  the  administration 
of  radium  internally  in  all  cases  of  low  vitality;  in  severe 
grades  of  anemia;  heart  disease  of  various  forms,  particu- 
larly those  associated  with  a  myocarditis;  or  where  there  are 
severe  degenerative  changes  in  the  nervous  system.  The 
profound  changes  in  the  blood  and  blood-pressure  are  liable 
to  cause  considerable  disturbance  in  hysterical  cases,  also  in 
women  about  the  time  of  the  menopause,  and  for  the  same 
reason  cases  of  pulmonary  tuberculosis  where  there  exists 
a  tendency  to  hemorrhage. 

Conclusions. — The  exact  status  of  these  radio-active  ele- 
ments in  internal  medicine  is  by  no  means  a  settled  question, 
perhaps  the  observations  in  some  instances  have  been  greatly 
exaggerated;  yet,  at  the  same  time,  from  an  experimental 
stand-point,  these  elements  produce  changes  which  have 
been  noted  by  most  careful  observers  who  practically  agree 
upon  the  salient  points,  and  from  their  deductions  it  is 
rational  to  adopt  some  of  the  conclusions  which  have 


288  RADIUM  IN  INTERNAL  MEDICINE 

brought  about  the  application  of  these  elements.  But  as 
most  of  the  diseases  in  which  they  have  been  employed 
belong  to  a  class  for  which  certain  forms  of  treatment  have 
been  periodically  promulgated  to  be  used  for  a  short  time, 
and  finally  be  forgotten,  more  proof  must  be  given  of  their 
efficiency  before  they  can  be  universally  adopted. 


CHAPTER   XXL 
THORIUM  IN  INTERNAL  MEDICINE. 

Properties  of    Thorium — Lethal   Doses — Methods — Rheumatism — Gout — 
Anemia — Leukemia — Diseases  of  the  Circulatory  and  Nervous  Systems. 

THE  physical  properties  of  thorium  X  have  led  to  its 
almost  universal  adoption  for  internal  administration.  Of 
all  these  radio-active  elements  it  is  best  adapted  for  this 
purpose;  the  reason  being  its  rapid  decay.  If,  for  instance, 
a  given  quantity  of  a  soluble  salt  of  radium  is  taken  into 
the  body,  it  is  absorbed,  and  most  of  it  is  eliminated  as 
radium  in  the  same  proportion,  except  that  small  amount 
which  passes  into  the  emanation  during  the  cycle  and 
which  remains  in  the  tissues.  If  it  is  supposed  that  the 
radio-activity  of  this  salt  is  to  be  the  therapeutic  agent, 
only  that  portion  which  changes  into  the  emanation,  and 
then  the  small  portion  of  the  emanation  which  changes 
into  the  "product  of  active  decay,"  will  fulfil  this  mission. 
The  emanation  being  a  gas,  will,  like  all  gases,  be  elimi- 
nated through  the  lungs  and  to  some  extent  by  other 
excretory  organs.  Most  of  this  emanation  leaves  the  body 
before  it  has  time  to  change  into  the  lower  radium  elements, 
and  thus  under  these  circumstances  rapid  elimination  is 
to  be  expected.  If  the  salt  of  radium  is  insoluble,  the 
"radium  element"  remains  in  the  system  somewhat  longer; 
but  the  same  eliminative  process  holds  in  regard  to  the 
emanation  which  it  produces.  In  comparison  \vith  this, 
19 


290 


THORIUM  IN  INTERNAL  MEDICINE 


the  salts  of  thorium  show  a  radical  difference,  and  should, 
from  a  therapeutic  stand-point,  be  more  efficient  under  these 
conditions.  The  element  employed  is  thorium  X,  an  element 
of  the  salt-forming  class,  with  a  disintegration  period  of 
about  the  same  time  as  radium  emanation.  Its  disintegration 
forms  the  thorium  emanation,  which  is  also  a  gas  but  with 
a  very  rapid  period  of  disintegration,  being  a  cycle  of  only 

FIG.  71 


Apparatus  for  charging  air  with  the  thorium  emanation.  Large  flask 
contains  lime  for  drying  the  air,  while  the  small  flask  contains  one  of  the 
thorium  elements. 


a  few  seconds.  It  then  passes  into  thorium  A,  which  has  a 
still  shorter  life.  This  is  the  first  element  of  the  "product 
of  active  change;"  it  disintegrates  by  degrees  to  thorium 
B.  Under  these  circumstances  the  amount  of  energy  is  far 
greater  than  that  eliminated  by  radium  in  the  same  space  of 
time;  and,  therefore,  if  this  energy  is  of  therapeutic  value, 
it  would  seem  that  thorium  X  is  bv  far  the  most  rational 


THORIUM  IN  INTERNAL  MEDICINE  291 

to  be  employed  for  internal  administration.  Even  where 
the  emanation  is  employed,  if  it  is  taken  into  the  lungs  as 
a  gas,  the  circulation  absorbs  it  and  before  it  is  returned 
to  the  lungs  again  it  has  been  changed  to  a  solid  that  must 
be  eliminated  by  such  organs  as  serve  that  purpose. 

From  the  observation  of  the  effects  of  thorium  upon 
individuals,  and  from  experiments  upon  animals  it  has 
proved  to  be  much  more  active  than  radium;  and  large 
doses  of  these  thorium  elements  must  be  given  with  care, 
particularly  to  the  weak  and  debilitated.  Deaths  from  this 
cause  have  been  reported;  therefore  the  administration  of 
large  amounts  of  radio-active  solutions  is  attended  with 
more  or  less  risk,  and  under  all  circumstances  must  be 
carefully  guarded.  The  effect  upon  the  blood-pressure  is 
sudden  and  profound,  swinging  from  a  decided  increase, 
which  may  be  maintained  for  some  time,  to  a  rapid  decline, 
passing  as  far  below  the  normal  as  it  had  been  above. 
These  changes  are  not  prone  to  be  accepted  without  a 
marked  impression  upon  the  whole  body,  and  caution  must 
be  used  in  those  conditions  attended  with  a  poor  cardio- 
vascular system. 

The  internal  employment  of  thorium  X  for  its  thera- 
peutic value  has  been  recommended  in  such  diseases  as  the 
various  forms  of  rheumatism,  gout,  in  blood  diseases,  such 
as  pernicious  anemia,  leukemia  of  various  kinds,  and  even 
to  reduce  the  amount  of  fat  in  extreme  cases  of  corpulency. 
In  all  these  cases  the  desired  action  of  the  thorium  is  that 
of  a  powerful  alterative,  causing  an  extremely  rapid  tissue 
change;  and,  by  the  effect  upon  the  metabolism  of  the 
body,  causes  a  reconstruction  and  thus  restores  healthy 
conditions. 


292  THORIUM  IN  INTERNAL  MEDICINE 

In  some  acute  diseases  it  has  been  employed  to  absorb 
an  exudate,  and  with  its  effect  upon  blood-pressure,  von 
Noorden  has  found  it  to  be  of  value  in  croupous  pneumonia, 
the  daily  amount  being  about  100  Mac-he  units  per  liter, 
and  its  influence  is  believed  to  be  upon  the  air  in  the  lung 
from  ,  the  contained  emanation.  Where  radium  or  thorium 
is  to  be  employed  hypodermically  or  intravenously,  it  should 
be  prepared  in  a  sterile  ampula  and  given  under  aseptic- 
precautions,  the  dosage  depending  upon  the  element. 

In  common  with  the  other  radio-active  elements,  it  has 
a  decided  diuretic  action,  which  in  gout  seems  to  be  of  more 
or  less  value.  Combined  with  this  action  is  the  powerful 
effect  upon  the  blood;  and  according  to  His,  the  proportion 
of  uric  acid  contained  in  the  urine  and  blood  is  decidedly 
altered.  The  metabolism  of  all  nitrogen  products  is  favored. 

Gout.— Gout  may  be  treated  either  by  the  drinking  of 
waters  containing  thorium  X,  or  air  may  be  drawn  through 
the  water  containing  thorium  X,  which  is  constantly  giving 
off  the  emanations;  this,  taken  into  the  lungs,  enters  the 
circulation.  In  these  cases,  however,  the  amount  of  water 
taken  into  the  system  aids  somewhat  the  elimination  of  the 
effete  products. 

Anemias. — Both  'the  primary  and  secondary  forms  are 
most  decidedly  benefited  by  these  radio-active  elements. 
In  the  secondary  forms  resulting  from  hemorrhage  due  to 
various  causes,  such  as  gastric  ulcer  or  duodenal  ulcer,  also 
those  incidental  to  childbirth,  recovery  may  be  hastened 
by  the  administration  of  waters  charged  with  this  element. 
Obstmate  cases  of  chlorosis  will  be  assisted,  especially  in 
the  exaggerated  grades.  The  administration  of  iron  also 
seems  to  be  necessary. 


LEUKEMIA  293 

In  pernicious  anemia  these  radio-active  elements  have 
in  some  instances  produced  an  increase  in  the  blood  supply 
for  a  temporary  period.  The  changes  that  have  been 
observed  are  by  no  means  constant,  and  while  a  few 
react  favorably  for  a  time,  in  many  others  absolutely  no 
change  is  observed;  this  may  be  due  to  the  fact  that  very 
fewr  practitioners  have  the  courage  to  give  large  enough 
doses  to  produce  this  change,  realizing  that  by  so  doing 
death  is  likely  to  occur,  and  since  the  benefit  enjoyed  is  at 
least  only  temporary,  it  would  seem  that  these  large  doses 
are  scarcely  justifiable.  The  secondary  anemia  has  been 
treated  by  the  administration  of  radio-active  waters  by  the 
mouth  or  by  inspiration  of  air  containing  the  emanation, 
but  Meseth1  recommends  the  injection  of  a  solution  of 
thorium  X,  given  slowly  and  injected  deeply  into  the  gluteal 
region.  He  usually  begins  with  a  solution  containing 
about  50  electrostatic  units,  increasing  gradually  to  about 
300;  each  injection  is  given  about  five  to  seven  days  apart, 
the  total  number  being  from  six  to  twelve.  The  more  severe 
grades  of  anemias  are  all  treated  by  hypodermic  or  intra- 
venous injection,  the  strength  of  the  solution  varying  with 
the  judgment  of  the  observer,  as  no  standard  has  been 
established. 

Leukemia,  both  the  lymphatic  and  myelogenic  varieties, 
has  been  treated  by  all  forms  of  radiation  and  often  tem- 
porarily benefited,  and  if  under  some  conditions  one  form  of 
radiation  fails,  this  is  no  indication  that  the  other  will  not 
prove  beneficial.  The  fact  is  frequently  observed  that  in 
cases  where  the  Roentgen  rays  produce  no  improvement, 
they  will  be  singularly  influenced  by  these  radio-active 

1  Munch,  mod  Woch.,  September,  1913. 


294  THORIUM  IN  INTERNAL  MEDICINE 

elements;  and  in  those  cases  of  myelogenic  leukemia  where 
the  spleen  is  greatly  enlarged,  powerful  applications  of 
mesothorium  will  reduce  this  organ  considerably,  with 
the  same  improvement  in  the  general  symptoms.  Besides 
the  local  application,  the  method  that  has  been  employed 
with  some  success  is  the  intravenous  injections  of  thorium 
X.  The  amount  of  improvement  is  still  questionable,  and 
while  some  have  reported  what  they  consider  brilliant 
results,  others  have  failed  to  observe  any  change  whatsoever. 
Rosenow1  presents  a  series  in  which  the  injections  of  thorium 
X  failed  to  produce  the  least  improvement.  One  case, 
however,  is  particularly  interesting,  where  the  blood-counts 
are  given,  showing  the  effect  of  these  injections  in  com- 
parison with  the  Roentgen  rays. 

A  Russian  woman,  aged  thirty-six  years,  developed 
myelogenic  leukemia  three  years  before  coming  under 
observation,  and  was  for  a  time  treated  by  the  Roentgen 
rays  with  some  benefit.  At  that  time  the  leukocyte  count 
was  159,000  and  dropped  to  11,300;  while  the  red  cells 
were  increased  to  4,140,000,  the  hemoglobin  from  58  to  80 
per  cent.  The  spleen,  which  was  several  finger-breadths 
below  the  border  of  the  rib,  receded  until  it  was  well  within 
that  line.  For  a  time  her  general  condition  was  good,  but 
about  a  year  after  the  treatment  was  discontinued  she  was 
in  practically  the  same  condition  as  when  she  first  came 
under  observation.  At  this  time  it  was  decided  to  try 
the  injections  of  thorium  and  the  following  table  gives 
the  results: 

1  Munch,  med.  Woch.,  October  7,  1913. 


LEUKEMIA 


295 


Date. 

Hemo- 
globin. 

Red. 

White. 

Date. 

Hemo- 
globin. 

Red. 

White. 

Nov.  14 

60 

3,632,000 

110.8001 

Jan.  2 

42 

2,720,000 

64,000* 

15 

114,000 

4 

•  • 

4 

16 

98,400 

6 

44 

2,802,000 

60.2004 

17 

80,000 

9 

4 

18 

52 

3,061,800 

98,200 

11 

50 

3,016,000 

54,000 

19 

118,200 

14 

4 

20 

40 

120.0002 

16 

58 

3,245,000 

43.0004 

21 

32 

2,910,000 

103,000 

18 

4 

23 

30 

3,182,000 

89,600 

19 

60 

3,290,000 

31.9004 

24 

40- 

2,980,000 

100,000 

23 

25 

40 

3,190,000 

93,000 

24 

4 

27 

40 

3,184,000 

86,0002 

25 

34,6004 

29 

40 

3,750,000 

62,800 

27 

4 

Dec.  1 

38 

3,331,000 

60,400 

28 

4 

3 

42 

3,344,000 

54,800 

30 

4 

4 

3 

Feb.  1 

58 

3,678,000 

33,400 

7 

50 

3,590,000 

64,000 

4 

4 

10 

50 

3,541,000 

59,000 

6 

58 

3,496,000 

24,600 

11 

50 

3,262,000 

68.0002 

8 

4 

14 

47,000 

11 

55 

3,100,800 

19,2004 

16 

42 

2,852,000 

60,000 

13 

4 

17 

40 

3,198,000 

72,400 

17 

48 

2,932,000 

31,800 

18 

.  .  .  .  2 

19 

55 

3,523,000 

44.0002 

20 

40 

3,240,000 

95,200 

22 

55 

3,127,400 

28,600 

22 

44 

2,870,000 

81,600 

Mar.  1 

2 

23 

4 

7 

32 

1,872,000 

27,800 

24 

4 

13 

33 

2,124,000 

25,400 

25 

42 

2,500,000 

116,000 

15 

2 

27 

4 

26 

20 

1,040,000 

78,200 

30 

4 

The  patient  complained  of  more  or  less  pain  over  the 
area  of  the  enlarged  spleen,  and  it  was  for  this  reason  the 
change  in  treatment  was  adopted.  Death  occurred  the  day 
following  the  last  treatment  and  the  postmortem  showed 


1  Thorium  X  solution,  containing  the  equivalent  of  0.4  mg.  of  radium, 
given  intravenously. 

-  Thorium  X  solution,  containing  the  equivalent  of  0.5  mg.  radium,  given 
intravenously. 

3  Thorium    X    solution,  containing   the   equivalent    of   0.4  mg.   radium, 
given  intravenously. 

4  Splenic  area  subjected  to  the  Roentgen  rays. 


290  THORIUM  IN  INTERNAL  MEDICINE 

the  usual  conditions  to  be  expected  in  these  cases.  The 
author  states  that  possibly  more  effect  could  have  been 
produced  if  larger  doses  of  thorium  X  had  been  employed; 
but  the  woman's  condition  was  such  that  he  did  not  care 
to  risk  the  toxic  effect,  which,  when  produced,  cannot  be 
controlled.  In  contrast  to  the  foregoing  Meseth1  reports 
the  following  case: 

A  man,  aged  forty-six  years,  first  came  under  observation 
five  years  before.  At  that  time  he  had  previously  been 
treated  by  the  Roentgen  rays,  and  during  another  period 
by  arsenic.  He  had  also  submitted  at  one  time  to  some 
surgical  operation.  For  a  time  he  improved  under  the 
Roentgen  rays,  but  became  discouraged  and  then  tried  injec- 
tion of  the  kakodylates.  The  highest  count  of  the  leukocytes 
at  this  time  was  about  58,000,  but  usually  ranged  between 
12,000  and  30,000,  and  while  the  spleen  was  greatly  reduced 
in  size  it  never  approximated  normal,  while  it  had  extended 
three  finger-breadths  below  the  border  of  the  ribs,  and  the 
blood  always  showed  the  presence  of  myelocytes.  About  a 
year  previous  to  this  report  the  patient  was  placed  upon 
injection  of  thorium  X,  given  twice  weekly,  and  the  strength 
of  the  solution  varied  from  100  to  300  electrostatic  units. 
Fifteen  injections  were  given,  and  this  brought  the  leukocytes 
down  to  6,000.  The  myelocytes  had  disappeared  and  the 
spleen  could  scarcely  be  felt.  Some  time  afterward,  when 
he  was  again  seen,  the  leukocytes  had  risen  to  12,000. 
Another  injection  of  thorium  X  was  given  and  since  then 
the  patient  has  been  in  a  fair  condition  of  health. 

Thorium  X  may  be  employed  for  lowering  the  pressure 
of  the  circulation  in  diseases  of  the  cardiovascular  system. 

1  Munch,  med.  Woch.,  September,  1913. 


LEUKEMIA  297 

Where  it  is  employed,  small  amounts  should  be  given  so  as 
to  accustom  the  organs  to  it.  This  is  best  accomplished  by 
giving  it  in  drinking-water,  or  by  breathing  the  emanation 
directly  from  an  emanation  apparatus.  Diseases  such  as 
myocarditis  and  arteriosclerosis  have  been  treated  by  this 
method  with  considerable  benefit  from  the  fact  that  their 
blood-pressure,  when  lowered,  remains  constant  for  some 
time,  allowing  the  circulatory  system  to  regain  its  tone  by 
meeting  with  less  resistance. 

Neuritis  of  various  forms  may  be  relieved  by  the  radio- 
activity of  thorium,  which  may  be  taken  into  the  system  in 
drinking-water;  or  in  acute  cases  local  injection  of  thorium 
X  may  be  found  to  be  of  value.  As  in  cases  of  sciatica, 
injection  along  the  course  of  that  nerve  of  from  100  to 
300  electrostatic  units,  given  at  intervals  of  a  few  days, 
will  aid  in  the  relief  of  these  most  obstinate  conditions. 

The  lancinating  pains  of  tabes  will  be  relieved  by  intra- 
muscular injection  of  thorium  X,  best  given  in  the  gluteal 
region.  While  it  has  no  effect  upon  the  course  of  the  disease, 
the  relief  afforded  in  these  cases  is  a  distinct  advance. 


CHAPTER   XXII. 
RHEUMATISM,  GOUT,  AND  ALLIED  DISEASES. 


Radium  Salts  in  Solution — Emanation  in  Solution — Arthritis,  Acute 
and  Chronic — Infectious  Arthritis — Arthritis  Deformans — Gout. 


WHILE  the  exact  pathology  of  diseases  included  in  this 
class  is  not  definitely  understood,  the  adoption  of  any  form 
of  treatment  for  their  relief  has  been  purely  upon  empiric 
grounds.  Perhaps  they  may  be  due  to  a  toxemia  from 
poisons  eliminated  within  the  economies  of  the  individual, 
or  they  may  be  due  to  some  influence  from  without;  in 
either  event  the  cause  is  not  definitely  known,  and  therefore 
at  the  present  time  is  of  no  material  concern.  Radium  or 
mesothorium  introduced  into  the  system  produces  more  or 
less  reaction,  depending  upon  the  dosage  and  the  idiosyn- 
crasies of  the  individual.  From  this  reaction  certain  results 
are  observed  where  the  manifestations  are  a  local  inflam- 
mation of  tissue,  accompanied  with  pain  and  tenderness.  A 
subsidence  will  be  noticed  with  a  restoration  of  the  parts 
to  a  normal  condition.  Later  cases  writh  distinct  changes 
in  structure  are  also  benefited  by  the  relief  from  pain,  and 
by  checking  to  some  extent  the  advance  of  the  disease,  even 
at  times  when  these  changes  have  passed  to  the  stage  of 
producing  actual  deformities.  Such  conditions  as  simple 
and  chronic  arthritis,  chronic  muscular  rheumatism,  pro- 
gressive polyarthritis,  infantile  arthritis,  gonorrheal  mono- 
arthritis,  polyarthritis,  arthritis  deformans,  and  gout,  have 


RHEUMATISM,  GOUT,  AND  ALLIED  DISEASES     299 

been  included  in  the  list.  In  the  last  two  diseases,  if  the 
condition  has  advanced,  only  temporary  improvement  and 
relief  can  be  given;  for,  if  the  bone  changes  have  passed  to 
the  stage  where  deformities  have  resulted,  repair  is  impos- 
sible. There  are  also  some  general  contra-indications  for 
the  use  of  these  radio-active  elements,  and  if  applied  or 
given  internally,  the  greatest  caution  should  be  exercised; 
the  most  important  are  those  where  a  tendency  to  pur- 
pura  is  observed,  and,  to  a  lesser  extent,  where  erythema 
exists.  It  must  be  remembered  that  where  these  elements 
are  introduced  into  the  system  the  changes  in  the  blood 
are  apt  to  be  at  times  somewhat  startling;  therefore  it  is 
necessary  to  proceed  carefully.  In  certain  forms  of  acute 
arthritis  of  the  specific  type,  or  a  very  acute  exacerbation 
of  an  old  process,  treatment  should  not  be  undertaken 
until  it  has  subsided  into  the  more  chronic  form.  With  the 
exclusion  of  these  few  contra-indications,  treatment,  if  well 
regulated  and  used  moderately,  will,  as  a  rule,  be  attended 
with  a  successful  issue. 

Cameron1  reports  a  list  of  66  cases  treated. 

In  this  list  he  has  divided  the  cases  according  to  the 
following  classification : 

Cases  are  placed  in  the  acute  stage  when  motion  in  the 
affected  joint  is  not  impaired  other  than  by  the  acute 
inflammatory  process,  and  when  there  is  a  constant  tem- 
perature curve. 

Subacide  Stage. — When  the  joint  can  be  moved  by 
voluntary  or  passive  motion  without  causing  additional  or 
recurring  local  inflammatory  symptoms  or  fluctuations  in 
temperature. 

1  Pi'iina.  Mod.  Jour.,  1913. 


300     RHEUMATISM,  GOUT,   AND  ALLIED  DISEASES 


. 

o 

a 

1 

.    a 
11 

•c       *: 
2        c 

3           o 

.9  y  £ 

Type  of  Cases. 

1  i 

1 

0            TJ 

rt    *^      *s     i-i    *a 

3     03      C   'E     C5 
£  !    O     -5     <U 

3    ^ 

o 

o.        S. 

C              3 

B  *9'+* 

fc 

~         0 

W 

Q 

Acute  primary  infectious  arthritis     . 

Subacute  primary  infectious  arthritis     . 

5 

5 

Chronic  primary  infectious  arthritis 

4 

2 

2 

Acute  secondary  infectious  arthritis 

3 

1 

2 

Subacute  secondary  infectious  arthritis. 

14 

1 

1 

7 

2 

3 

Chronic  secondary  infectious  arthritis   . 

17 

1 

2 

2 

5 

7 

Acute  primary  infectious  arthritis 

Subacute  primary  infectious  arthritis     . 

3 

3 

Chronic  primary  infectious  arthritis 

6 

1 

1 

2 

1 

1 

Acute  secondary  infectious  arthritis 

Subacute  secondary  infectious  arthritis. 

2 

1 

1 

Chronic  secondary  infectious  arthritis   . 

12 

4 

2 

2 

3 

1 

00 

7 

8       23 

11 

17 

Chronic  Stage. — When  degenerated  or  organized  exudates 
cause  fixation  and  deformity. 

The  method  of  treatment  outlined  in  these  cases  was  the 
inspiration  of  0.025  to  0.1  microcuries  per  liter  of  air,  in  an 
emanation  room,  for  at  least  one  and  one-half  hours  each 
day;  with  this,  1  liter  of  emanation  drinking-water  con- 
taining 15  to  20  microcuries  per  liter,  which  may  be  divided 
into  four  doses.  This  procedure  is  recommended  in  acute 
cases.  Where  they  tend  to  a  more  chronic  character  it  is 
necessary  to  carry  large  amounts  of  the  emanation  into 
the  system  by  more  and  stronger  emanation  waters,  and 
also  by  the  inspiration  of  charged  air  for  a  longer  period. 
If,  however,  the  patient  is  not  benefited  in  a  period  of  sixty 
days,  usually  the  case  can  be  regarded  as  one  not  suited  to 


1  Patients  not  under  treatment  long  enough,  for  any  effects. 


ACUTE  ARTICULAR  RHEUMATISM  301 

this  form  of  treatment.  Cameron  has,  however,  observed 
several  of  these  most  refractory  cases  yield  to  this  method. 
Under  some  circumstances  he  has  found  the  hypodermic  or 
intravenous  injection  of  radium  salts  beneficial,  and  regards 
the  dosage  of  25  to  100  micrograms,  administered  about 
every  ten  days,  as  being  perfectly  safe  except  in  cases  com- 
plicated by  any  heart  lesion  or  advanced  arteriosclerosis. 
The  microcurie  per  liter  adopted  in  these  observations 
equals  a  concentration  of  about  2700  Mache  units. 

The  wide  variation  of  different  methods  is  extremely 
interesting,  and  while  the  results  seem  to  be  about  the 
same  under  the  several  conditions,  the  application  of  one 
method  will  often  be  more  adaptable  to  the  convenience  of 
a  given  case. 

Acute  articular  rheumatism,  under  ordinary  circumstances, 
yields  to  the  administration  of  salicylates  and  the  adoption 
of  the  ordinary  routine  treatment.  However,  there  are  fre- 
quent instances  where  at  times  the  disease  seems  to  be 
rebellious,  and  where  such  conditions  prevail  the  use  of 
these  radio-active  elements  may  be  justifiable.  This  may 
be  accomplished  by  the  administration  of  emanation  water, 
which  should  be  slowly  sipped;  in  this  manner  the  emana- 
tion is  taken  into  the  body  slowly  and  is  eliminated  in  the 
same  manner;  or  a  small  emanator  for  charging  the  air  of 
the  room  may  be  installed  for  the  patient's  use.  Packs  or 
baths  may  also  be  employed.  The  amount  of  emanation 
recommended  has  been  from  about  200  to  10,000  Mache 
units  per  day.  Von  Noorden,  in  the  treatment  of  these 
cases,  has  seldom  given  less  than  200  Mache  units  per 
liter  per  day  or  more  than  1200.  Under  the  influence  of 
this  dosage  the  results  have  been  most  favorable;  but  he 
believes  that  severe  endocarditis  or  pericarditis  complicating 


302      RHEUMATISM,   GOUT,   AND  ALLIED  DISEASES 

acute  rheumatism  is  a  centra-indication  for  the  employment 
of  this  form  of  treatment,  due  to  the  effects  upon  blood- 
pressure. 

Secondary  chronic  articular  rheumatism  should  not  be  treated 
until  the  source  of  infection  has  been  relieved.  Upon  the 
removal  of  the  offending  foci  the  use  of  the  emanation  of 
radium  or  the  radium  salts  is  justifiable,  and  only  the  small 
dosage  of  about  100  Mache  units  should  be  employed.  The 
best  re.sults  are  observed  in  those  instances  where,  after  the 
general  conditions  have  subsided,  the  remaining  infection 
has  localized  in  one  joint. 

Arthritis  of  gonorrheal  origin  is  often  benefited  by  the  local 
application  of  radium,  and  even  in  the  later  stages,  where 
considerable  exudates  have  been  thrown  out  about  the 
joint,  much  relief  is  afforded  by  the  absorption  of  the 
products  of  inflammation. 

Arthritis  of  specific  origin  is  not  benefited  to  a  degree 
worth  considering. 

Chronic  rheumatic  arthritis  of  different  types  may  be 
relieved  and  10  some  extent  the  fibrous  exudate  may  be 
absorbed.  Where,  however,  there  has  been  absorption  of 
the  joint  surfaces,  with  erosion,  the  outlook  is  more  or  less 
hopeless ;  though  it  may  be  possible  even  under  these  circum- 
stances to  soften  the  process  to  some  extent  and  allow  the 
limbs  to  be  placed  in  better  position.  The  muscular  contrac- 
tion that  has  taken  place  coincidently  often  limits  this 
correction.  Both  the  local  and  internal  use  of  radium  is 
employed  in  these  cases;  the  emanation  taken  internally 
by  breathing  charged  air,  or  the  sipping  of  emanation 
water;  locally  by  baths,  packs,  compresses  of  the  emanation, 
or  the  use  of  radium  from  an  applicator  giving  off  a  high 
activity.  The  emanation  of  radium  is  employed  in  doses 


ARTHRITIS  DEFORM  AN  S  303 

of  100  to  1200  Mac-he  units  per  liter  per  day.  In  those 
cases  where  these  applications  cause  a  rise  of  temperature, 
caution  must  be  exercised. 

Arthritis  deformans,  one  of  the  most  rebellious  forms  of 
joint  manifestation,  has  to  some  extent  been  strikingly 
benefited  by  the  use  of  radium.  Pinch  (London  Radium 
Institute)  has  adopted  the  following  technique  in  the 
treatment  of  cases  in  that  institution.  The  individual 
receives  250  c.c.  of  radium  emanation  solution  of  a  strength 
varying  from  1  to  2  microcuries  per  liter  each  day,  and 
this  form  of  treatment  must  be  continued  for  a  long  time. 
Usually,  after  the  daily  administration  of  the  amount  for 
about  six  weeks,  some  slight  improvement  is  noticed.  In 
favorable  cases  the  articular  and  muscular  pains  lessen  and 
disappear,  the  movement  of  the  joints  is  much  freer,  with 
less  grating,  the  muscles  controlling  the  affected  joints 
regain  to  some  extent  their  lost  tone,  and  the  general  health 
of  the  patient  decidedly  improves.  Attention  is  called  to 
the  diuretic  action  of  the  emanation,  and  at  the  same  time 
it  seems  to  be  slightly  laxative  but  not  purgative.  Out  of  a 
series  of  21  cases  1  was  cured,  9  improved,  5  did  not  improve, 
1  abandoned  treatment,  1  was  rejected,  while  4  still  continue 
under  active  treatment.  The  details  of  a  few  cases  may 
be  interesting: 

A  woman,  aged  fifty-two  years;  disease  of  twelve  years' 
duration.  First  symptoms  were  limitation  of  flexion  at  the 
hip-joint  and  pain  under  the  gluteus  maximus  of  an  inter- 
mittent character.  These  symptoms  gradually  increased 
in  severity  for  ten  years,  but  in  about  one  year  before 
treatment  began  she  had  an  acute  exacerbation,  and  all 
movements  at  the  hip-joint  became  restricted  and  attended 
with  intense  pain.  This  increased  until  it  became  so  severe 


304     RHEUMATISM,  GOUT,  AND  ALLIED  DISEASES 

and  constant  that  she  was  only  able  to  sleep  for  half  an 
hour  at  a  time,  and  became  extremely  worn  and  emaciated. 
Every  possible  form  of  treatment,  dietetic  and  medicinal, 
had  been  tried  without  effect.  This  patient  was  under 
treatment  for  about  eleven  weeks,  but  no  improvement  was 
noticed  for  six  weeks.  From  that  time  on  it  was  both 
steady  and  rapid,  and  a  year  later,  when  seen,  she  could 
sleep  in  any  position  without  discomfort,  stand  without 
effort,  and  even  button  her  shoes,  which  she  had  not  done 
for  over  ten  years. 

A  man,  aged  thirty-five  years,  came  under  observation 
with  disease  of  nine  years'  duration,  which  started  in  the 
knee-joint,  and  was  thought  to  be  tuberculous.  Splints 
were  placed  upon  the  joint  which  caused  ankylosis.  A 
year  or  so  later  the  disease  appeared  in  the  wrist  and 
elbowr;  these  also  become  completely  ankylosed  and  other 
joints  were  also  affected,  but  to  a  smaller  extent.  The 
patient  had  been  treated  with  hot  air,  pine-  and  electric- 
baths,  high-frequency  massage,  and  various  forms  of  medi- 
cine, but  nothing  served  to  arrest  the  progress  of  the  disease. 
He  was  given  two  courses  of  treatment  with  radium  emana- 
tion solution.  Each  course  lasted  six  weeks,  and  the  patient 
drank  250  c.c.  of  this  solution  every  day  except  Sundays. 
There  was  an  intermission  between  each  course  of  treatment 
of  about  four  months.  A  month  later  he  was  examined  and 
found  to  be  much  freer  in  all  movements  and  also  free  from 
pain.  He  could  dress  himself  completely  without  help, 
except  putting  on  his  shoes.  His  general  health  was  excellent. 
Other  cases  are  also  mentioned  with  equally  encouraging 
results,  and,  like  most  of  this  class,  other  forms  of  treatment 
had  failed  or  produced  only  very  transient  amelioration  of 
the  symptoms. 


GOUT  305 

Gout. — These  radio-active  elements  have  been  employed  in 
the  treatment  of  gout;  and  some  claim  that  success  followed 
their  efforts,  more  particularly  by  influencing  the  course  of 
the  disease  than  relieving  the  inflammatory  conditions. 
In  fact,  the  acute  stage  of  this  disease  is  regarded  by  some 
as  being  a  contra-indication  for  the  employment  of  these 
elements.  Where  the  disease  has  progressed  to  the  stage  of 
malformation  very  little  benefit  is  to  be  derived  from  this 
form  of  treatment,  but  the  influence  upon  the  metabolic 
changes  in  the  system  no  doubt  has  some  effect  upon  its 
course.  The  treatment  in  these  cases  is  usually  confined 
to  the  drinking  of  emanation  waters  in  conjunction  with 
baths  and  local  applications.  The  amount  of  wrater  taken 
into  the  body  also  aids  to  some  extent  in  carrying  off 
the  effete  products,  while  the  elimination  of  the  nitrogen 
products  is  also  decidedly  altered.  The  inhalation  of 
air  charged  with  the  emanation  is  also  practised;  but 
the  injection,  intravenously  or  hypodermically,  is  rarely 
necessary. 

Gout,  being  a  disease  that  seems  to  be  influenced  to  a 
great  degree  by  dietetic  changes,  may  be  often  benefited 
by  this  regimen  alone;  therefore,  when  the  cases  are  placed 
under  treatment,  this  important  point  must  be  given  some 
attention.  It  also  explains  why  so  many  of  these  cases 
are  benefited  in  well-equipped  sanatoria  and  not  in  their 
own  homes. 


20 


CHAPTER   XXIII. 

TREATMENT  OF  UNTOWARD  EFFECTS   OF 
RADIO-ACTIVE  ELEMENTS. 


Acute    Burns — Chronic  Dermatitis — Comparison  with  Roentgen  Burns- 
Thorium  Dermatitis. 


THE  deleterious  effects  of  these  radio-active  elements 
upon  the  patient  or  the  laboratory  worker  do  not  seem  to 
be  so  refractory  or  dangerous  as  those  of  similar  nature 
received  from  the  Roentgen  rays.  Some  have  ascribed 
this  to  the  care  exercised  in  handling  these  elements, 
sufficient  warning  having  been  obtained  from  disasters 
caused  in  the  early  days  of  Roentgenology.  This,  however, 
cannot  be  the  real  basis,  for  it  is  evident  that  numerous 
burns  have  been  caused  experimentally  and  accidentally, 
and  they  invariably  yield  in  a  shorter  time  than  similar 
conditions  of  Roentgen-ray  origin.  However,  we  must 
consider  these  "burns"  in  exactly  the  same  manner  from 
their  method  of  origin,  and  divide  them  into  acute  and 
chronic,  due  to  the  length  of  time  of  exposure  to  the 
activity  of  these  elements.  Likewise,  the  patient  is  the 
usual  sufferer  from  an  acute  "burn,"  while  the  laboratory 
worker  will  be  the  subject  of  the  chronic  "burn." 

Acute  burns  usually  appear  at  an  indefinite  period  after 
the  exposure  to  one  of  these  radio-active  elements,  and  may 
result  from  one  application  or  a  series  of  them.  The  extent 
and  character  depend  upon  the  amount  of  radiation  received 
and  the  idiosyncrasy  of  the  individual.  The  pain  varies 


EFFECTS  OF  RADIO-ACTIVE  ELEMENTS         307 

in  these  cases  and  in  no  way  seems  to  be  dependent  upon 
it.  The  time  required  for  recovery  is  much  shorter  than 
that  observed  in  x-ray  cases,  and  both  the  subjective  and 
objective  symptoms  are  equally  rebellious.  The  pain  often 
necessitates  a  general  narcotic,  continued  from  the  pre- 
ulcerative  stage  to  long  after  the  scar  has  formed.  The 
ulcer  should  be  dressed  according  to  the  usual  surgical 
procedures.  Ointments  of  various  kinds  have  been  recom- 
mended and  tried,  but  they  are  of  doubtful  value. 

In  those  cases  where  there  is  only  a  slight  blistering  or 
even  an  ulceration  of  the  superficial  structure,  treatment 
of  any  form  is  not  necessary,  except  for  protection  that 
would  naturally  be  given.  Healing  in  these  instances  is 
usually  prompt,  as  the  whole  course  is  often  only  a  period 
of  a  few  weeks,  and  the  patient  suffers  very  little  dis- 
comfort during  its  active  stage;  in  fact,  in  some  instances, 
where  applications  have  been  made  in  diseases  where  pain 
existed,  the  relief  from  suffering  is  frequently  observed 
under  these  circumstances. 

Where  these  burns  occur  in  conjunction  with  Roentgen 
treatment  the  ulceration  closely  resembles  that  of  the 
Roentgen  burn  and  not  that  of  the  radio-active  elements; 
this  is  not  difficult  to  explain.  If  the  tissues  have  been 
damaged  by  the  Roentgen  rays,  then  the  radiation  of  these 
elements  is  more  or  less  localized  and  these  tissues,  not 
being  able  to  resist  the  influence  of  the  combined  radiation, 
necessarily  break  down.  This  condition  is  well  illustrated 
by  the  case  of  sarcoma  of  the  sternum  reported  under  that 
designation  in  Chapter  XVII,  Fig.  61. 

Here  the  healing  has  been  most  protracted,  and  the 
whole  course  resembled  more  the  Roentgen  burn,  although 
decidedly  more  localized. 


308  EFFECTS  OF  RADIO-ACTIVE  ELEMENTS 

The  treatment  of  these  cases,  like  those  due  to  the 
Roentgen  rays  alone,  is  extremely  refractory,  and  nothing 
so  far  recommended  seems  to  influence  their  course  in  the 
least;  healing  is  extremely  slow,  and  the  accompanying 
symptoms  may  be  just  as  variable  as  those  of  the  true 
.  Roentgen  ulcer. 

Workers  in  radium  laboratories  are  subjected  to  a  con- 
dition differing  from  the  usual  action  of  radiation,  in 
that  usually  the  period  of  warning  is  sufficient  to  allow 
the  victim  to  recover  without  the  more  malignant  effects 
seen  in  the  worker  of  the  Roentgen  laboratory.  Where  these 
workers  are  exposed  to  the  rays  alone,  they  usually  develop 
a  condition  of  the  hands  that  renders  them  extremely 
sensitive  to  heat  and  cold,  noticed  particularly  in  washing 
or  handling  hot  or  cold  objects.  This  is  especially  apparent 
about  the  finger-nails.  If  the  person  withdraws  from  his 
vocation  and  ceases  to  handle  these  radio-active  elements 
the  condition  rapidly  subsides,  and  in  a  few  weeks  or 
months  he  may  return  to  duty  and  be  perfectly  comfort- 
able until  the  exposure  again  causes  this  same  condition  of 
hyperesthesia. 

A  number  of  these  attacks  at  times  produces  more  lasting 
results,  such  as  an  anesthetic  condition  of  the  affected 
part,  attended  at  times  with  peeling  of  the  skin,,  which, 
while  not  as  a  rule  painful,  is  most  objectionable  and 
annoying. 

When,  however,  the  person  is  handling  naked  radio- 
active elements,  the  effect  is  quite  different,  and  depends 
to  some  extent,  upon  whether  that  element  is  a  gas  or  a 
solid;  although  in  either  case  if  it  once  touches  the  surface 
of  the  body  it  cannot  be  removed  without  also  including 
the  surface.  Reference  to  this  phenomena  has  been  made 


EFFECTS  OF  RADIO-ACTIVE  ELEMENTS         309 

under  other  headings.  Therefore,  if  one  of  these  elements 
should  come  in  contact  with  the  body,  the  result  must  be 
a  burn  of  some  degree,  and,  strange  as  it  may  seem,  these 
processes  are  not  so  violent  as  similar  conditions  from  the 
Roentgen  ray;  the  erythema  produced  not  being  so  uniform 
over  the  radiated  area.  Although  milder  in  character,  they 
produce  irritation,  and  while  so  far  no  cases  of  actual 
malignancy  have  been  reported  with  the  increase  in  the 
manufacture  of  this  product  and  the  usual  carelessness 
observed,  there  is  every  likelihood  that  these  conditions 
will  be  noticed  in  the  future. 

Thorium  dermatitis  has  been  reported  among  workers 
in  this  earth.  It  resembles  a  mild  Roentgen-ray  dermatitis 
of  a  chronic  character.  Keratosis,  warts,  stiff  hairs,  usually 
appearing  upon  the  hands  and  upon  the  exposed  portions 
of  the  body,  were  thought  at  first  to  be  due  to  the  irritating 
property  of  these  thorium  products,  but  could  be  attributed 
more  probably  to  their  radio-activity.  The  only  relief  in 
these  cases  is  simply  to  have  the  victims  abandon  their 
occupation. 


INDEX. 


ACNE,  185 

hypertrophic,  186 
rosacea,  186 
vulgaris,  185 
Actinium,  45 
Actinium-A,  46 
Actinium-B,  46 
Actinium-C,  46 
Actinium-D,  47 
A  ctinium  emanation,  46 
Actinium-X,  46,  117 
Action,  astringent,  178 
atrophic,  178 

decongestive,  178 
stimulative,  143,  176 
upon  bacteria,  156 
upon  blood,  159,  162 
upon  bone  marrow,  285 
upon  ferments,  162 
upon  fish  roe,  148 
upon  globulins,  157 
upon  heart,  285 
upon  kidneys,  166 
upon  lungs,  161 
upon  metabolism,  160,  284 
upon  oats,  149 
upon  plants,  149 
upon  secretory  glands,  163 
upon  skin,  176 
Active    deposit    of  rapid   change, 

actinium,  46 
radium,  31 
thorium,  42 

of  slow  change,  radium,  32 
Adenitis,  tuberculous,  265 
Adenoma,  265 
Air  as  a  filter,  128 


Alpha  particle,  49 

range  of,  51,  52 
Alopecia  areata,  65 
Ampule,  292 
Analgesic  effect,  275 
Anemia,  286,  292 

pernicious,  292 
Angiokeratoma,  181 
Angiomata,  272 

cavernous,  273 

erectile,  274 
Application  of  actinium,  116 

of  radium,  87 

of  thorium,  108 

of  uranium,  119 
Applicators,  89,  123,  214 
Arthritis,  298,  302 
Atomic  theory,  18 


B 

BACTERIA,  156 
Bandages,  88 
Baths,  277 
Benign  tumors,  199 
Beta  ray,  54 
Blood  changes,  162 
Blood-pressure,  285 
Burns,  146,  306 


CALORIC  value,  65 

Canal  rays,  57 

Carcinoma,  213,  237 
of  bladder,  200 
of  breast,  241 


312 


INDEX 


Carcinoma  of  gall-bladder,  240 

of  larynx,  233 

of  liver,  240 

of  neck,  226 

of  ovary,  210 

of  penis,  201 

of  rectum,  238 

of  stomach,  238 

of  testicle,  201 

of  thyroid,  246 

of  tongue,  232 

of  uterus,  206 

of  vagina,  210 
Caries,  195 
Cashe,  131 
Cathode  particle,  54 
Chalazion,  192 
Charcoal,  92 
Cicatricial  bands,  192 
Clothing,  88 
Cross-fire,  135 
Comparison  with  Roentgen   rays, 

163 

Compresses,  276 
Corpulency,  286 
Curie,  71 
Cyst,  265 
Cystitis,  197 


DEPILATORY  action,  179 
Dermatitis,  309 
Dermatology,  175 
Diabetes  mellitus,  286 
Diseases  of  hair,  179 

treated  by  radio-active  water,  170 
Disintegration  series,  22 
Diuretic  action,  162 
Dosage,  282 
Dynamic  property,  48 
Dyskeratosis,  181 


ECZEMA,  181 
acute,  182 
lichenoides,  181 
non-pruriginous,  181 
seborrheic,  181 
varicosum,  181 


Electrometer,  83 
Electron,  54,  63 
Electroscope,  76 

alpha  ray,  78 

beta  and  gamma  rays,  81 
Electrostatic  unit,  72 
Elements,  22 
Emanation  of  actinium,  46 

of  radium,  28,  91 

of  thorium,  42,  112 
Emanator,  gas,  103,  281,  290 

water,  99,  284 
Emanatoria,  166 
Episclerosis,  192 
Epithelioma,  219 

of  breast,  245 

of  face,  222 

of  hand,  235 

of  lip,  224 

of  mouth,  230 

of  palate,  229 

scar  tissue,  236 

of  tongue,  228 

of  vulva.  212 
Equilibrium,  59 

of  radium,  36 
Erythema,  190,  309 
Exophthalmic  goitre,  268 


FAVUS,  180 
Fibroma,  205 

of  penis,  201 
Fibrous  scars,  201 
Filters.    See  Screens,  128 

aluminium,  131 

lead,  133 

Fluorescence,  36,  63 
Fontactoscope,  82,  170 


G 

GAMMA  ray,  56 
Glaucoma,  192 
Glioma,  251 
Goitre.  268 
Gout,  285,  292,  305 
Granulomata,  274 
Gynecology,  202 


INDEX 


313 


HAIR,  179 

Heat,  development  of,  65 

Helium,  49 

Herpes  zoster,  183,  276 

Hodgkin's  disease,  254 

Hypertrichosis,  180 

Hypodermic  injection,  101 

Hypopyon,  192 


ICHTHYOSIS,  185 

Idiosyncrasies,  145 

Implantation,  139 

Internal  administration,  101,  159 

Intravenous  injections,  101 

Ionium,  25 

lonization,  56,  63 

of  different  gases,  77 

method,  measurement  by,  75 
Ions,  54,  63 


KAPOSI'S  disease,  285 
Keloid,  192,  257 
Keratitis,  192 
Keratosis,  180 
Kilo-uranium,  70 
Kilurane,  70 


LEUKOPLAKIA,  225 
Leukemia,  118,  286,  293 
Lichen,  184 
Local  application  of  radium,  86 

of  thorium,  108 
Luminescence  of  •  the  eye-ground. 

192 

Luminosity,  65 
Lupus  erythematosus,  189 

verrucosus,  189 

vulgaris,  187 
Lymphadenoma,  254 
Lymphosarcoma,  254 


M 

MACHE  unit,  72 

Malignancy,  215 

Malignant  disease,  206,  215 

Maturation,  122,  127 

Mesothorium,  106 

Mesothorium  I,  40 

Mesothorium  II,  40 

Methods  of  applying  radium,  86 
of  estimating  amount  of  radia- 
tion, 75 

of  estimation  by  gamma-ray,  80 
by  fluorescence,  83 
by  photographic  plate,  83 

Metritis,  204 

Microcurie,  71 

Millicurie,  71 

Milligram-hour,  73 

Milligram-minute,  73 

Milligram-second,  73 

Minerals,  26,  37 

Moles,  274 

Mud,  radio-active,  169,  277 

Mycosis  fungoides,  254 


N 


NERVOUS  system,  diseases  of,  286 
Neuralgia,  275 
Neurasthenia,  198 
Neuritis,  297 
Neurodermatitis,  182 
Neyi,  272 

pigmented,  274 
Nitron,  28 


FACET'S  disease,  242 
Pain,  157 

Papilloma.  200,  262 
of  larynx,  263 


314 


INDEX 


Papilloma  of  mouth,  264 

of  trachea,  263 
Paraffine,  140 
Penetration,  58 
Period  of  half  change,  61 

of  life,  60 
Periodic  law,  17 
Pessary,  203 
Phosphorescence,  63 
Photographic  effect,  57 
Physical  properties  of  apparatus, 

120 

Physiological  action,  143 
Pigmentation,  143 
Polonium,  34 
Polypi,  263 

nasal,  114 
Pneumonia,  285 
Potassium,  21 

Preparation  of  applicators,  137 
Prostate,  198 
Pruritus,  183,  276 
Psoriasis,  184,  195 
Pulmonary  diseases,  285 
Pyelitis,  198 
Pyelonephritis,  198 


RADIABILITY,  131 
Radiant  matter,  34,  54 
Radio-actinium,  46,  116 
Radio-active  air,  102 

constant,  62 

earth,  169 

water,  100 
Radio-activity,  48 

of  air,  66 

of  springs,  168 
Radiode,  127 
Radio-lead,  33 
Radio-telurium,  41,  106 
Radio-thorium,  41,  106 
Radium,  25,  35,  86 

A,  31 

B,  32 

C,  32 
clock,  55 

D,  33 

E,  34 

F,  34 


Radium,  internal  medicine,  280 
Reaction,  145.    Sec  Action. 
Rheumatism,  285,  298,  301 
Rhinophyma,  186 
Rodent  ulcer,  223 
Roentgen  burns,  236 

ray,  57 
Rubidium,  21 


S 


SALTS  of  radium,  36 
Sarcoma,  212,  247 

endothelial,  251 

fibro-,  250 

hemorrhagic,  255 

maxilla,  253,  250 

melanotic,  252 

neck,  252 

of  thigh  (periosteal),  253 
Saturation  current,  63 
Scars,  vicious,  260 
Screens.     See  Filters,   128. 
Sea  water,  26 

Secondary  radiation,  58,  130 
Selective  action,  92 
Shober's  apparatus,  92 
Spectrum,  28 
Spinthariscope,  50 
Spring  catarrh,  191 
Springs,  167 
Stenosis  of  trachea,  195 
Stimulation,  143 
Strutt's  clock,  55 
Surpenctrant  radiation,  132 
l  Sycosis,  180 
|  Syphilis,  186 
Systemic    disturbance    from    local 

action,  156 


TELANGIECTASIS,  146 
Tenia,  180 
Thorium,  38,  43,  106 

A,  B,  C,  and  D,  43 

dermatitis,  40,  309 

emanation,  42 

internal  medicine,  289 

therapeutic  properties,  39,  106 


INDEX 


315 


Thorium  X,  41,  110 

Trachoma,  191 

Treatment    of    Roentgen     burns, 

164 
Toiles,  122 

radium,  88 
Tuberculous  adenitis,  265 

diseases  of  bones,  268 

infection  of  eye,  190 

laryngitis,  267 

ulceration,  189,  196 
Tumors  of  bladder,  199 


ULCER  of  cornea,  192 
Ultra-violet  ray,  56,  188 
Uranium,  23,  69,  118 

II,  24 

unit,  69,  74 

X  and  Y,  24 
Urethritis,  199,  204 
Urinary  system,  197 


VARNISH  applicators,  125 
Vegetations,  203 
Vessication,  145 
Vicious  scars,  192,  260 
Volt  per  hour,  74 
per  minute,  74 

W 

WARTS,  199,  260 
Waters,  radio-active,  166 
Wax,  radio-active,  140 
Wells,  radio-active,  166 


XERODERMA  pigmentosa,  185 
X-ray  tube,  57 
X-rays,  57 


ZOSTERIFORM  ichthyosis,  184 


WN 
340 
N439r 
1914 

BiomedicaJ 
Library 


